Epidemiology of Adrenal Insufficiency Among Elderly Patients in a Convalescent Care Unit and One Year Outcome

Objective: Adrenal insufficiency (AI) is associated with significant morbidity and mortality. The diagnosis of AI in elderly people is difficult with its non-specific presentation. The aim of this study is to describe the epidemiology, pattern of comorbidity and one- year outcome among elderly people after their initial diagnosis of AI. Materials and Methods: Patients aged >65 years, who underwent the Short Synacthen test (SST) done during the period of 1.1.2014 to 30.6.2019, were retrieved. Basic demographic information, comorbidities as measured by the Charlson Comorbidity index (CCI), cause for admission, length of stay, one year unplanned readmission and death were recorded. Results: Two hundred forty two patients with the mean age of 79.6 (standard deviation 8.75) were identified. The causes for admission were pneumonia (22.3%), electrolytes abnormalities (11.6%) urinary tract infection (UTI) (8.6%) and poor oral feeding (7.8%). Ninety four (38.3%) were diagnosed to have AI. The most common indication for SST was electrolytes abnormalities. Unplanned readmission was present in 52.7% of patients. Inpatient mortality was 11.6% and one year mortality was 44.8%. There was no statistically significant difference between the AI and normal response group in age, gender, CCI score, length of stay, cause for admission, indication for SST and mortality. However, the AI group had a much lower baseline cortisol level (389 nmol/L vs. 192.4 nmol/L, p