Infection risk higher in Addison’s disease and congenital adrenal hyperplasia

  • Tresoldi AS & al.
  • J Clin Endocrinol Metab
  • 18 Sep 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In the primary care setting, the risk for lower respiratory tract infections (LRTIs), urinary tract infections (UTIs) and gastrointestinal infections (GIIs) was higher in patients with primary adrenal insufficiency (PAI) compared with population-based matched control participants.
  • Findings suggest that glucocorticoid therapy might at least partly drive the increased infection risk observed in PAI.

Why this matters

  • Healthcare professionals treating PAI patients should be alert to the possibility of infections in these patients.
  • Findings may provide a case for recommending a vaccination strategy in PAI to reduce the risk for infections and related morbidity and mortality.

Study design

  • Study of 1580 patients with Addison’s disease (AD; mean age, 51.7 years) and 602 patients with congenital adrenal hyperplasia (CAH; mean age, 35.4 years) using The Health Improvement Network (THIN) database.
  • AD patients matched with 3158 unexposed patients. 
  • Outcome: incidence of infections and antimicrobial prescription counts.
  • Funding: Medical Research Council UK.

Key results

  • Patients with AD and CAH were prescribed hydrocortisone (82% and 37.8%), prednisolone (11.8% and 50.0%), cortisone acetate (5.8% and 4.3%) and dexamethasone (0.4% and 5.9%, respectively).
  • Patients with AD exposed to glucocorticoids vs unexposed had significantly increased risk for (all P>.001):
    • GIIs (adjusted incidence rate ratio [aIRR], 3.80; 95% CI, 2.99-4.84),
    • LRTIs (aIRR, 2.11; 95% CI, 1.64-2.69) and
    • UTIs (aIRR, 1.51; 95% CI, 1.29-1.77).
  • CAH cohort exposed to glucocorticoids vs unexposed had significantly increased risk for:
    • UTIs (aIRR 1.40; 95% CI, 1.06-1.85; P=.02) and
    • LRTIs (aIRR 2.36; 95% CI, 1.25-4.42; P=.01).
  • Patients with AD had increased prescription rates of (all P<.001 style="list-style-type:circle;">
  • antibiotics (aIRR, 1.73; 95% CI, 1.69-1.77) and
  • antifungals (aIRR, 1.89; 95% CI, 1.74-2.05).
  • Glucocorticoid-treated CAH patients vs unexposed had significantly higher prescription rate of (all P<.001 style="list-style-type:circle;">
  • antibiotics (aIRR, 1.77 [95% CI, 1.66-1.89] vs 1.15 [95% CI, 1.08-1.23]) and
  • antifungals (aIRR,1.91 [95% CI, 1.50-2.43] vs 1.47 [95% CI, 1.18-1.83]).
  • Limitations

    • Some degree of misclassification of the exposed cohorts and of the different episodes of infection.

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