Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data

Sarpreet S. Sekhon; Katelynn Crick; Tyler W. Myroniuk; Kevin S. C. Hamming; Mahua Ghosh; Denise Campbell-Scherer; Roseanne O. Yeung


J Endo Soc. 2022;6(4) 

In This Article

Abstract and Introduction


Context: Adrenal insufficiency (AI) is an uncommon, life-threatening disorder requiring lifelong treatment with steroid therapy and special attention to prevent adrenal crisis. Little is known about the prevalence of AI in Canada or healthcare utilization rates by these patients.

Objective: We aimed to assess the prevalence and healthcare burden of AI in Alberta, Canada.

Methods: This study used a population-based, retrospective administrative health data approach to identify patients with a diagnosis of AI over a 5-year period and evaluated emergency and outpatient healthcare utilization rates, steroid dispense records, and visit reasons.

Results: The period prevalence of AI was 839 per million adults. Patients made an average of 2.3 and 17.8 visits per year in the emergency department and outpatient settings, respectively. This was 3 to 4 times as frequent as the average Albertan, and only 5% were coded as visits for AI. The majority of patients were dispensed glucocorticoid medications only.

Conclusion: The prevalence of AI in Alberta is higher than published data in other locations. The frequency of visits suggests a significant healthcare burden and emphasizes the need for a strong understanding of this condition across all clinical settings. Our most concerning finding is that 94.3% of visits were not labeled with AI, even though many of the top presenting complaints were consistent with adrenal crisis. Several data limitations were discovered that suggest improvements in the standardization of data submission and coding can expand the yield of future studies using this method.


Adrenal insufficiency (AI) is an uncommon, life-threatening condition with a rising prevalence.[1,2] AI is the result of a deficit in the production or action of glucocorticoids[3] and with potential associated deficiency in mineralocorticoids and/or adrenal androgens. In terms of anatomical classification, primary AI is due to a defect in the production of hormones in the adrenal cortex. Primary AI can be due to various causes including autoimmune, infectious, trauma, genetic, malignancy, and drug-induced etiologies.[3] Impaired adrenocorticotropic hormone production at the pituitary or corticotropin-releasing hormone at the hypothalamus are classified as secondary and tertiary AI, respectively.[3] AI is certainly of topical concern given its rising prevalence,[1,4] as well as the rising rates of opioid dependence, that have brought this etiology of central AI to the forefront.[5] There is also significant geographical variability in its prevalence: the lowest occurrence reported has been in Japan at 5 cases per million and the highest in Norway at 144 cases per million.[2,6,7]

As with any medical condition, appropriate allocation of services relies on using accurate measures to understand the needs of a population.[8] The use of administrative health data has powerful potential when investigating uncommon conditions that are generally limited by recruitment and sample size in traditional or retrospective analysis studies.[9] By identifying cases using administrative health data, variations in prevalence in local areas as well as during different time periods can be estimated.[9] Thus far, there are limited epidemiological data on AI in Canada. Furthermore, intranational comparisons are limited by distinct healthcare systems in each province or territory. Studies in the United States have shown that patients with AI have higher rates of healthcare utilization compared to matched controls.[10,11] Knowledge of the local prevalence of AI, the number of services used for its treatment, and the most common reasons these patients present for care would ensure adequate resource allocation.

The primary objectives of this study were to determine the period prevalence of AI over a 5-year period (January 1, 2014 to December 31, 2018) and to determine the rates of emergency and outpatient healthcare utilization among this patient population in Alberta, Canada. Secondary objectives of this analysis were to describe the glucocorticoid and mineralocorticoid medication dispensation of these patients and the most common reasons for visiting the emergency department (ED) and outpatient clinics.