Table 4.
Clinical characteristics at admission of narrowly defined cases of AC and non-narrowly defined cases of AC
| Narrowly defined case | Non-narrowly defined case | ||
|---|---|---|---|
| (n = 201) | (n = 303) | ||
| Age(years) | Median [IQR] | 72 (60–81) | 70 (57–79.5) |
| <40 yr | 18 (9.0) | 29 (9.6) | |
| ≧40 yr. <60 yr | 31 (15.4) | 57 (18.8) | |
| ≧60 yr. <80 yr | 95 (47.3) | 141 (46.5) | |
| ≧80 yr | 57 (28.4) | 76 (25.1) | |
| Male | 102 (50.7) | 153 (50.5) | |
| Predisposing disease | Primary AI | 7 (3.5) | 16 (5.3) |
| Central AI | 75 (37.3) | 61 (20.1) | |
| Others | 119 (59.2) | 226 (74.6) | |
| Indication for hospital admissiona | Adrenal insufficiencyb | 52 (25.9) | 30 (9.9) |
| Pituitary disease | 41 (20.4) | 33 (10.9) | |
| Cancer | 7 (3.5) | 67 (22.1) | |
| Infection | 15 (7.5) | 41 (13.5) | |
| Cardiovascular disease | 7 (3.5) | 14 (4.6) | |
| Sepsis | 6 (3.0) | 11 (3.6) | |
| Adrenal tumor | 4 (2.0) | 6 (2.0) | |
| AI-related clinical symptomc | 40 (19.9) | 18 (5.9) | |
| Therapeutic GC regimen | HC | 149 (74.1) | 179 (59.1) |
| mPSL | 24 (11.9) | 50 (16.5) | |
| DEX | 15 (7.5) | 29 (9.6) | |
| Others | 13 (6.5) | 45 (14.9) | |
| Hormone testing | ACTH | 178 (88.6) | 56 (18.5) |
| Cortisol | 194 (96.5) | 64 (21.1) | |
| Endocrine stimulation testd | 27 (13.4) | 13 (4.3) | |
| Adrenal cortex stimulation test | 15 (7.5) | 6 (2.0) | |
| Visited before admission | Yes, within 90 days before | 124 (61.7) | 213 (70.3) |
| Yes, within 14 days before | 90 (44.8) | 151 (49.8) | |
| Under GC-related medication | Oral GC | 33 (16.4) | 71 (23.4) |
| HC equivalent daily dosage (mg) | 20 (12–30) | 20 (20–40) | |
| Median [IQR] | |||
| Intranasal GC | 0 (0.0) | 0 (0.0) | |
| Inhaled GC | 8 (4.0) | 7 (2.3) | |
| Drug interacting with GC | 4 (2.0) | 9 (3.0) |
Abbreviations: AI adrenal insufficiency, GC glucocorticoid, HC hydrocortisone, mPSL methylprednisolone, DEX dexamethasone, ACTH adrenocorticotropic hormone, IQR Interquartile.
aIdentified as disease or symptom requiring decision to admit registered in the DPC system
bConsidering the following admission and therapeutic GC administration, this group is consistent with hospitalization due to adrenal crisis
cConsisted of unspecified coma, hyponatremia, unspecified hypotension, volume depletion, shock, anorexia, nausea, vomiting, unspecified fever and hypoglycemia
dEndocrine stimulation test consists of hormone dynamic testing of the following: anterior pituitary (growth hormone, gonadotropin, thyroid stimulating hormone, prolactin, adrenocorticotropic hormone), posterior pituitary (antidiuretic hormone), thyroid, parathyroid, and gonad (testosterone, estradiol). Endocrine tests of adrenocorticotropic hormone included insulin tolerance test, metyrapone test, dexamethasone suppression test, and corticotropin-releasing hormone stimulation test. In this study, we counted results of the adrenal cortex stimulation test apart from those for endocrine stimulation tests. The adrenal stimulation tests evaluates adrenal cortex function, which is related to glucocorticoid or mineralocorticoid, for example, the adrenocorticotropic hormone stimulation test