What is the incidence of adrenal crisis?

Updated: Feb 14, 2018
  • Author: Lisa Kirkland, MD, FACP, FCCM, MSHA; Chief Editor: George T Griffing, MD  more...
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Answer

The incidence of primary adrenocortical insufficiency is variable and depends on the defining cortisol level and the method of testing (ie, ACTH stimulation versus single random cortisol level). The underlying disease also is a factor. Studies of critically ill patients with septic shock demonstrate a de novo (excluding patients with known adrenal insufficiency or patients on glucocorticoid therapy) incidence ranging from 19-54%. Secondary adrenal insufficiency has been demonstrated in 31% of patients admitted to a critical care unit.

Annane et al's landmark 2002 study found a very high rate, ie, 76% of all enrolled patients with septic shock. Of the general perioperative population, in 62,473 anesthetic administrations, only 419 (0.7%) patients required glucocorticoid supplementation and only 3 hypotensive events were thought to be attributable to glucocorticoid deficiency. [6] Studies of patients undergoing cardiac or urologic surgery reveal an incidence of 0.01-0.1%. In a study of 2000 consecutive general hospital autopsies, only 22 (1.1%) revealed bilateral adrenal hemorrhage; however, as many as 15% of patients dying in shock have been demonstrated to have BMAH.

The aforementioned study from the Netherlands, by Smans et al, found the incidence of adrenal crisis among persons with primary adrenal insufficiency to be 5.2 cases per 100 person-years, while in secondary adrenal insufficiency, the incidence was reported as 3.6 cases per 100 person-years. [4]

In a study of Swiss patients with either primary or secondary adrenal insufficiency, Notter et al found the prevalence of adrenal crisis to be 4.4 per 100 disease-years. [7]

According to a report by Chabre et al, the annual incidence of adrenal crisis in Europe is estimated to be 6-8 cases per 100 adrenal insufficiency patients. [8]

No description regarding racial data, sexual predilection, or age is available in the literature.


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