Trends in hospital admissions for adrenal insufficiency in adolescents and young adults in the 21st century

BackgroundVery little is known about the epidemiology of adrenal crises (AC) and adrenal insufficiency (AI) in adolescents and young adults. MethodsData on all admissions to Australian hospitals between 2000/1 to 2019/20 for a principal diagnosis of AI (including AC) in 10-24 year olds were extracted from a national repository. Age and sex-specific rates and age-adjusted rates were compared. FindingsOver the study, there were 3386 admissions for a principal diagnosis of AI; 24.0% (n=812) were for an AC and 50 center dot 7% (n=1718) were for secondary AI. Age-adjusted AI admissions increased from 31 center dot 70/million in 2000/1 to 54 center dot 68/million in 2019/20 (p<0 center dot 0001). Age-adjusted AC admissions also increased, most notably in the second decade (from 5 center dot 80/million in 2010/11 to 15 center dot 75/million in 2019/20) (p<0 center dot 00001). Average AI and AC admission rates were comparable between the sexes, but rates increased significantly in females, especially in those aged 20 to 24 years, whose AC rate in 2019/20 (39 center dot 65/million) was significantly higher than the corresponding rate in 2000/1 (3 center dot 15/million) (p<0 center dot 00001). Average age-adjusted SAI admission rates were higher in males (23 center dot 92/million) than females (15 center dot 47/million) (p<0 center dot 00001). However, SAI admission rates increased only among females (from 11 center dot 81/million to 22 center dot 12/million in 2019/20), with an increase in 20-24 year old females in the second decade from 5 center dot 07/million in 2010 to 20 center dot 42/million (p<0 center dot 00001). Age adjusted admissions for congenital adrenal hyperplasia, primary AI (PAI) and drug-induced AI did not change significantly over the study. InterpretationAC/AI admissions increased over the first two decades of this century in the emerging adult population, particularly among females who also experienced a marked increase in AC admission rates, most evident in the second decade. Although uncertain, possible explanations include: dose of glucocorticoid replacement; non-adherence to therapy; psychosocial factors; and difficulty in transition to adult services. Admissions for SAI also increased, while rates of PAI and CAH remained constant.