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Incidence and Risk Factors for Adrenal Crisis in Pediatric-onset Adrenal Insufficiency: A Prospective Study

Mayumi Hosokawa1,2,3, Yosuke Ichihashi1,2, Yasunori Sato4

  • 1Japanese Multicenter Study for Adrenal Crisis (JMSAC), Tokyo 160-8582, Japan.

The Journal of Clinical Endocrinology and Metabolism
|December 21, 2023
PubMed

Insights

Pediatric patients with adrenal insufficiency (AI) face a significant risk of adrenal crisis (AC). Younger age and frequent infections are key risk factors for developing AC in children with AI.

Area of Science:

  • Pediatric Endocrinology
  • Adrenal Gland Disorders
  • Clinical Research

Background:

  • Adrenal crisis (AC) is a severe complication in patients with adrenal insufficiency (AI).
  • Limited prospective data exists on AC in pediatric primary and secondary AI.

Purpose of the Study:

  • To investigate the incidence and identify risk factors for adrenal crisis (AC) in children with AI.
  • To provide crucial data for managing pediatric AI patients and preventing AC.

Main Methods:

  • A multicenter, prospective cohort study in Japan involving 349 children (age ≤15 years) with AI.
  • Incidence calculated per person-year (PY); risk factors analyzed using Poisson regression.

Main Results:

  • The study recorded 41 AC events in 31 patients over 961 PY, yielding an incidence of 4.27 per 100 PY.
  • Younger age at enrollment (RR 0.93) and increased infections (RR 1.17) were significant risk factors for AC.
  • Female sex, primary AI, and hydrocortisone dosage were not significant risk factors.

Conclusions:

  • A considerable number of pediatric-onset AI patients experience adrenal crisis (AC).
  • Younger age and a higher frequency of infections independently increase AC risk in this population.
Abstract

Keywords:
adrenal crisisadrenal insufficiencyincidenceprospective studyrisk factor

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