Clinical risk factors for the development of Addisonian crises in patients with primary adrenal insufficiency

Relevance: Primary adrenal insufficiency (PAI) is a rare but clinically significant disease characterized by polymorphic symptoms and the risk of severe complications. Addisonian crisis is a life-threatening complication of this disease, accompanied by arterial hypotension, dehydration, and metabolic disorders. Identification of clinical risk factors is important for preventing disease decompensation.

Aim of the study: To identify clinical risk factors for the development of Addisonian crises in patients with primary adrenal insufficiency.

Materials and methods: A retrospective-prospective analysis was conducted in 100 patients treated at a specialized endocrinology center during 2017–2024. Clinical symptoms, anthropometric parameters, arterial blood pressure, disease duration, frequency of Addisonian crises, and comorbidities were assessed. At the prospective stage, patients were dynamically monitored against the background of replacement therapy. Statistical analysis was performed using descriptive statistics and the χ² test; p<0.05 was considered statistically significant.

Results: The study included 100 patients with PAI. The mean age of the patients was 36.4±17.1 years (min–max: 18–74), the mean body weight was 62.3±13.2 kg (min–max: 38–98), and the mean height was 1.66±0.08 m (min–max: 1.48–1.85). The mean disease duration was 5.3±7.1 years (min–max: 0–25), indicating the clinical heterogeneity of the patient group. Women predominated in the gender structure (68%), while men accounted for 32%. Analysis of body mass index showed that normal or reduced values prevailed in most patients: underweight was observed in 30%, normal weight in 40%, overweight in 20%, and obesity in 10%. The clinical presentation was polymorphic. The most common symptoms were general weakness (95%), arterial hypotension (90%), skin hyperpigmentation (85%), and weight loss (75%). Dizziness (65%), craving for salty foods (60%), abdominal pain (55%), and nausea (50%) were also recorded. Analysis of clinical risk factors showed that Addisonian crises occurred significantly more often in patients with arterial hypotension, weight loss, and shorter disease duration (p<0.05). The risk of crisis development was higher in patients with disease duration of less than 1 year compared with patients with longer disease duration (p<0.05). It was also found that irregular intake of replacement therapy was associated with an increased frequency of crises (p<0.05). According to the results of prospective follow-up, the frequency of Addisonian crises significantly decreased against the background of adequate therapy, and the severity of clinical symptoms was reduced (p<0.05).

Conclusion: Addisonian crises are a frequent complication of primary adrenal insufficiency. The main clinical risk factors include arterial hypotension, weight loss, and short disease duration. Adherence to replacement therapy is important in preventing crises. The obtained results confirm the need for early identification and regular follow-up of patients.