{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T01:41:15Z","timestamp":1791423675455,"version":"4.3.3"},"reference-count":27,"publisher":"The Endocrine Society","issue":"7","license":[{"start":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T00:00:00Z","timestamp":1613520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,16]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Mortality data in patients with adrenal insufficiency are inconsistent, possibly due to temporal and geographical differences between patients and their reference populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare mortality risk and causes of death in adrenal insufficiency with an individually matched reference population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study was done using a UK general practitioner database (CPRD). A total of 6821 patients with adrenal insufficiency (primary, 2052; secondary, 3948) were compared with 67564 individually-matched controls (primary, 20366; secondary, 39134). Main outcomes were all-cause and cause-specific mortality, and hospital admission from adrenal crisis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With follow-up of 40 799 and 406 899 person-years for patients and controls respectively, the hazard ratio (HR [95% CI]) for all-cause mortality was 1.68 [1.58-1.77]. HRs were greater in primary (1.83 [1.66-2.02]) than in secondary (1.52 [1.40-1.64]) disease; primary versus secondary disease (1.16 [1.03-1.30]). The leading cause of death was cardiovascular disease (HR 1.54 [1.32-1.80]), along with malignant neoplasms and respiratory disease. Deaths from infection were also relatively high (HR 4.00 [2.15-7.46]). Adrenal crisis contributed to 10% of all deaths. In the first 2 years following diagnosis, the patients\u2019 mortality rate and hospitalization from adrenal crisis were higher than in later years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Mortality was increased in adrenal insufficiency, especially primary, even with individual matching and was observed early in the disease course. Cardiovascular disease was the major cause but mortality from infection was also high. Adrenal crisis was a common contributor. Early education for prompt treatment of infections and avoidance of adrenal crisis hold potential to reduce mortality.<\/jats:p><\/jats:sec>","DOI":"10.1210\/clinem\/dgab096","type":"journal-article","created":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T19:58:01Z","timestamp":1613591881000},"page":"e2759-e2768","source":"Crossref","is-referenced-by-count":59,"title":["Increased Mortality Risk in Patients With Primary and Secondary Adrenal Insufficiency"],"prefix":"10.1210","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4392-269X","authenticated-orcid":false,"given":"Kanchana","family":"Ngaosuwan","sequence":"first","affiliation":[{"name":"Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, UK"},{"name":"Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desmond G","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian F","family":"Godsland","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Metabolic Medicine, St. Mary\u2019s Hospital, Imperial College NHS trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azeem","family":"Majeed","sequence":"additional","affiliation":[{"name":"School of Public Health, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-4869","authenticated-orcid":false,"given":"Jennifer K","family":"Quint","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Oliver","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Metabolic Medicine, St. Mary\u2019s Hospital, Imperial College NHS trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2021,2,17]]},"reference":[{"issue":"12","key":"2021080908315405400_CIT0001","doi-asserted-by":"crossref","first-page":"4849","DOI":"10.1210\/jc.2006-0076","article-title":"Premature mortality in patients with Addison\u2019s disease: a population-based study","volume":"91","author":"Bergthorsdottir","year":"2006","journal-title":"J Clin Endocrinol Metab."},{"issue":"5","key":"2021080908315405400_CIT0002","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1111\/j.1365-2265.2008.03340.x","article-title":"Increased death risk and altered cancer incidence pattern in patients with isolated or combined autoimmune primary adrenocortical insufficiency","volume":"69","author":"Bensing","year":"2008","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"3","key":"2021080908315405400_CIT0003","first-page":"1169","article-title":"The effect of hypopituitarism on life expectancy","volume":"81","author":"Bates","year":"1996","journal-title":"J Clin Endocrinol Metab."},{"issue":"1","key":"2021080908315405400_CIT0004","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1046\/j.1365-2265.1997.d01-1749.x","article-title":"Increased cerebrovascular mortality in patients with hypopituitarism","volume":"46","author":"B\u00fclow","year":"1997","journal-title":"Clin Endocrinol (Oxf)."},{"issue":"4","key":"2021080908315405400_CIT0005","first-page":"1420","article-title":"Pituitary adenomas in Sweden between 1958 and 1991: incidence, survival, and mortality","volume":"85","author":"Nilsson","year":"2000","journal-title":"J Clin Endocrinol Metab."},{"issue":"9254","key":"2021080908315405400_CIT0006","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S0140-6736(00)04006-X","article-title":"Association between premature mortality and hypopituitarism. 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