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

被引：1

作者：

Hosokawa, Mayumi ^{[1
,2
,3
]}

Ichihashi, Yosuke ^{[1
,2
]}

Sato, Yasunori ^{[4
]}

Shibata, Nao ^{[1
,5
]}

Nagasaki, Keisuke ^{[1
,5
]}

Ikegawa, Kento ^{[1
,6
]}

Hasegawa, Yukihiro ^{[1
,6
]}

Hamajima, Takashi ^{[1
,7
]}

Nagamatsu, Fusa ^{[1
,8
]}

Suzuki, Shigeru ^{[1
,9
]}

Numakura, Chikahiko ^{[1
,10
]}

Amano, Naoko ^{[1
,3
]}

Sasaki, Goro ^{[1
,11
]}

Nagahara, Keiko ^{[1
,12
]}

Soneda, Shun ^{[1
,13
]}

Ariyasu, Daisuke ^{[1
,14
]}

Maeda, Miwako ^{[1
,15
]}

Kamasaki, Hotaka ^{[1
,16
]}

Aso, Keiko ^{[1
,17
]}

Hasegawa, Tomonobu ^{[1
,2
]}

Ishii, Tomohiro ^{[1
,2
]}

机构：

[1] JMSAC, Tokyo 1608582, Japan

[2] Keio Univ, Sch Med, Dept Pediat, 35 Shinanomachi,Shinjuku Ku, Tokyo 1608582, Japan

[3] Saitama City Hosp, Dept Pediat, Saitama 3368522, Japan

[4] Keio Univ, Sch Med, Dept Prevent Med & Publ Hlth, Tokyo 1608582, Japan

[5] Niigata Univ, Dept Pediat, Med & Dent Hosp, Niigata 9518520, Japan

[6] Tokyo Metropolitan Childrens Med Ctr, Dept Endocrinol & Metab, Fuchu, Tokyo 1838561, Japan

[7] Aichi Childrens Hlth & Med Ctr, Dept Endocrinol & Metab, Obu 4748710, Japan

[8] Kumamoto Univ, Dept Pediat, Sch Med, Kumamoto 8608556, Japan

[9] Asahikawa Med Univ, Dept Pediat, Asahikawa, Hokkaido 0788510, Japan

[10] Yamagata Univ, Fac Med, Dept Pediat, Yamagata 9909585, Japan

[11] Tokyo Dent Coll, Ichikawa Gen Hosp, Dept Pediat, Ichikawa 2728513, Japan

[12] Showa Univ, Sch Med, Dept Pediat, Tokyo 1428555, Japan

[13] St Marianna Univ, Sch Med, Dept Pediat, Kawasaki, Kanagawa 2168511, Japan

[14] Kawasaki Municipal Hosp, Dept Pediat, Kawasaki, Kanagawa 2100013, Japan

[15] Oita Univ, Fac Med, Dept Pediat, Yufu 8795593, Japan

[16] Sapporo Med Univ, Dept Pediat, Sapporo, Hokkaido 0608556, Japan

[17] Toho Univ, Dept Pediat, Omori Med Ctr, Tokyo 1438541, Japan

来源：

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM | 2024年 / 109卷 / 08期

关键词：

adrenal insufficiency; adrenal crisis; incidence; risk factor; prospective study; COVID-19; CHILDREN;

D O I：

10.1210/clinem/dgad753

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Context: Adrenal crisis (AC) is a life-threatening complication that occurs during follow-up of patients with adrenal insufficiency (AI). No prospective study has thoroughly investigated AC in children with primary and secondary AI. Objective: This work aimed to determine the incidence and risk factors for AC in patients with pediatric-onset AI. Methods: This multicenter, prospective cohort study conducted in Japan enrolled patients diagnosed with AI at age <= 15 years. The incidence of AC was calculated as events per person-year (PY), and risk factors for AC were assessed using Poisson regression multivariable analysis. Results: The study population comprised 349 patients (164 male, 185 female) with a total follow-up of 961 PY. The median age at enrollment was 14.3 years (interquartile range [IQR] 8.5-21.2 years), and the median follow-up was 2.8 years (IQR 2.2-3.3 years). Of these patients, 213 (61%) had primary AI and 136 (39%) had secondary AI. Forty-one AC events occurred in 31 patients during the study period. The calculated incidence of AC was 4.27 per 100 PY (95% CI, 3.15-5.75). Poisson regression analysis identified younger age at enrollment (relative risk [RR] 0.93; 95% CI, 0.89-0.97) and increased number of infections (RR 1.17; 95% CI, 1.07-1.27) as significant risk factors. Female sex (RR 0.99; 95% CI, 0.53-1.86), primary AI (RR 0.65; 95% CI, 0.30-1.41), or equivalent dosage of hydrocortisone per square meter of body area (RR 1.02; 95% CI, 0.96-1.08) was not a significant risk factor. Conclusion: A substantial proportion of patients with pediatric-onset AI experience AC. Younger age and an increased number of infections are independent risk factors for developing AC in these patients.

引用

页码：e1602 / e1607

页数：6