Secondary adrenal insufficiency epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Epidemiology and Demographics
Incidence
- The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
- In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
Prevalence
- The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
- In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
- The prevalence of [disease/malignancy] is estimated to be [number] cases annually.
Case-fatality rate
- In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
- The case-fatality rate of [disease name] is approximately [number range].
Age
- Patients of all age groups may develop [disease name].
- The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
- [Disease name] commonly affects individuals younger than/older than [number of years] years of age.
- [Chronic disease name] is usually first diagnosed among [age group].
- [Acute disease name] commonly affects [age group].
Race
- There is no racial predilection to [disease name].
- [Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
Gender
- [Disease name] affects men and women equally.
- [Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
Region
- The majority of [disease name] cases are reported in [geographical region].
- [Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
Developed Countries
Developing Countries
In the United States, the prevalence of Addison’s disease per 1 million population is around 40-60 cases. Internationally, the occurrence of adrenal insufficiency is rare. In countries were epidemiological data is collected, the prevalence changes to 39 cases per 1 million population in the UK, 60 cases per 1 million population in Denmark. In Iceland, a study was conducted by Olafsson and Sigurjonsdottir that found a higher prevalence in this region, around 22.1 per 100,000 population. [10]
Morbidity and mortality associated with Addison disease are usually due to an inability to determine a diagnosis or a delay in diagnosing a patient with adrenal insufficiency or a failure to provide the patient with the adequate hormonal replacement therapy they need i.e. glucorticoid and mineralocorticoid replacement. [11]
Death may occur if acute addisonian crisis occurs without being promptly treated. This serious complication may occur as a new event (de novo) occurring in the presence of an adrenal hemorrhage or acutely on top of an inadequately treated adrenocortical insufficiency or a chronic case of insufficiency. With insidious chronic Addison disease debilitating symptoms may occur albeit low level and nonspecific. Despite diagnosis and adequate management, the risk of death in a patient with Addison disease is two times more likely, usually due to cardiovascular, malignant and infectious disease. [12]
The prevalence and risk factors for patients with Addison disease were analyzed using surveys by the authors White and Arlt. The following countries were included; United Kingdom, Canada, Australia, and New Zealand. The surveys found that about 8% of those that were diagnosed with Addison’s disease were hospitalized annually for adrenal crisis. Furthermore, the authors White and Arlt, found that patients suffering from Asthma, Diabetes Mellitus or had previously a GIT infection had an increased risk of getting Addison disease. [13][14] Moreover, a study by Chantzichristos et al indicated that patients who had type 1 or 2 diabetes, were likely to have higher mortality rates if they had Addison disease concomitantly over those that had diabetes alone. These same patients were followed up for almost 6 years and were found to have a mortality rate of 28% vs. 10% for those with diabetes and Addison vs. diabetes alone. Although it must be noted that cardiovascular deaths accounted for the highest mortality rate in both groups, nonetheless the relative overall mortality rate for one group over the other was estimated at 3.89. Other conditions such as diabetic complications, infectious disease and unknown causes along with Addison’s disease all tend to exacerbate the mortality rates versus diabetes alone. [15]
Race Addison disease has no specific predilection to any race.
Sex Addison disease that is autoimmune in origin and tending to be idiopathic is more commonly found in females and children.
Age Commonly, the age of presrntation is between 30-50 years of age., however, the disease may present itself earlier in association with other syndromes such as congenital adrenal hyperplasia, polyglandular syndromes or if the onset of Addison is secondary to a disorder of long chain fatty acid metabolism.