{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T07:15:30Z","timestamp":1783667730507,"version":"3.55.0"},"reference-count":21,"publisher":"The Endocrine Society","issue":"8","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare of Japan","doi-asserted-by":"publisher","award":["20FC1020"],"award-info":[{"award-number":["20FC1020"]}],"id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Adrenal crisis (AC) is a life-threatening complication that occurs during follow-up of patients with adrenal insufficiency (AI). No prospective study has thoroughly investigated AC in children with primary and secondary AI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This work aimed to determine the incidence and risk factors for AC in patients with pediatric-onset AI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This multicenter, prospective cohort study conducted in Japan enrolled patients diagnosed with AI at age \u226415 years. The incidence of AC was calculated as events per person-year (PY), and risk factors for AC were assessed using Poisson regression multivariable analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The study population comprised 349 patients (164 male, 185 female) with a total follow-up of 961 PY. The median age at enrollment was 14.3 years (interquartile range [IQR] 8.5-21.2 years), and the median follow-up was 2.8 years (IQR 2.2-3.3 years). Of these patients, 213 (61%) had primary AI and 136 (39%) had secondary AI. Forty-one AC events occurred in 31 patients during the study period. The calculated incidence of AC was 4.27 per 100 PY (95% CI, 3.15-5.75). Poisson regression analysis identified younger age at enrollment (relative risk [RR] 0.93; 95% CI, 0.89-0.97) and increased number of infections (RR 1.17; 95% CI, 1.07-1.27) as significant risk factors. Female sex (RR 0.99; 95% CI, 0.53-1.86), primary AI (RR 0.65; 95% CI, 0.30-1.41), or equivalent dosage of hydrocortisone per square meter of body area (RR 1.02; 95% CI, 0.96-1.08) was not a significant risk factor.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A substantial proportion of patients with pediatric-onset AI experience AC. Younger age and an increased number of infections are independent risk factors for developing AC in these patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgad753","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T21:01:10Z","timestamp":1703192470000},"page":"e1602-e1607","source":"Crossref","is-referenced-by-count":7,"title":["Incidence and Risk Factors for Adrenal Crisis in Pediatric-onset Adrenal Insufficiency: A Prospective Study"],"prefix":"10.1210","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7478-1485","authenticated-orcid":false,"given":"Mayumi","family":"Hosokawa","sequence":"first","affiliation":[{"name":"Japanese Multicenter Study for Adrenal Crisis (JMSAC) , Tokyo 160-8582 , Japan"},{"name":"Department of Pediatrics, Keio University School of Medicine , Tokyo 160-8582 , Japan"},{"name":"Department of Pediatrics, Saitama City Hospital , Saitama 336-8522 , 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5882-661X","authenticated-orcid":false,"given":"Keisuke","family":"Nagasaki","sequence":"additional","affiliation":[{"name":"Japanese Multicenter Study for Adrenal Crisis (JMSAC) , Tokyo 160-8582 , Japan"},{"name":"Department of Pediatrics, Niigata University Medical and Dental Hospital , Niigata 951-8520 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kento","family":"Ikegawa","sequence":"additional","affiliation":[{"name":"Japanese Multicenter Study for Adrenal Crisis (JMSAC) , Tokyo 160-8582 , Japan"},{"name":"Department of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center , Fuchu 183-8561 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1288-9455","authenticated-orcid":false,"given":"Yukihiro","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Japanese Multicenter Study for Adrenal Crisis (JMSAC) , Tokyo 160-8582 , Japan"},{"name":"Department of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center , Fuchu 183-8561 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0635-9009","authenticated-orcid":false,"given":"Takashi","family":"Hamajima","sequence":"additional","affiliation":[{"name":"Japanese Multicenter Study for Adrenal Crisis (JMSAC) , Tokyo 160-8582 , Japan"},{"name":"Department of Endocrinology and Metabolism, Aichi Children's Health and Medical Center , Obu 474-8710 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fusa","family":"Nagamatsu","sequence":"additional","affiliation":[{"name":"Japanese Multicenter Study for Adrenal Crisis (JMSAC) , Tokyo 160-8582 , Japan"},{"name":"Department of Pediatrics, Kumamoto University School of Medicine , Kumamoto 860-8556 , 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