Subjective health status in Norwegian patients with Addison's disease

• Published in: Clinical endocrinology (Oxford) Vol. 56; no. 5; pp. 581 - 588
• Main Authors: Løvås, Kristian, Loge, Jon Håvard, Husebye, Eystein S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.05.2002; Blackwell; Wiley Subscription Services, Inc
• Subjects: Addison Disease - complications; Addison Disease - drug therapy; Adrenals. Adrenal axis. Renin-angiotensin system (diseases); Adult; Aged; Biological and medical sciences; Case-Control Studies; Cortisone - analogs & derivatives; Cortisone - therapeutic use; Disability Evaluation; Endocrinopathies; Fatigue - drug therapy; Fatigue - etiology; Female; Fludrocortisone - therapeutic use; Glucocorticoids - therapeutic use; Health Status; Hormone Replacement Therapy; Humans; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Norway; Sex Factors; Social Isolation; Thyroid. Thyroid axis (diseases); Endocrinopathy; Human; Replacement therapy; Addison disease; Questionnaire; Adrenal cortex diseases; Fatigue; Subgroup; Vitality; Cortisone; Concomitant disease; Adrenal insufficiency; Hypocorticism; Adrenal gland diseases; Primary; Female; Perception; Failure; Comparative study
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1046/j.1365-2265.2002.01466.x

Summary objective  Many patients with Addison’s disease have complaints that might be related to the disease or to its treatment. However, only a few studies have addressed the subjective health status of patients with adrenocortical failure. The aim of the present study was to assess the subjective health status with special emphasis on fatigue among patients with Addison’s disease. subjects, design and measurement   In a postal survey, 79 patients with confirmed primary adrenal failure (Addison’s disease) completed the Short Form 36 (SF‐36) and the Fatigue questionnaires. The subjective health status in Addison’s disease was compared with normative data from the general population. results  General health and vitality perception were most consistently impaired in the patients with Addison’s disease. The scores on physical functioning and role‐physical were low in women. Social functioning and role‐emotional scores were also lower than normal in the female patients, but this was confined to the patients with autoimmune polyendocrine syndromes. Patients with autoimmune polyendocrine syndromes tended to have lower scores than patients with solitary Addison’s disease. The level of fatigue was higher than normal for both men and women. Working disability at ages 18–67 years was 26%, compared with 10% in the corresponding general Norwegian population. The high working disability increased with age and was higher in subgroups with concomitant endocrine diseases. Most subjective health parameters were lower among the disabled compared to the patients in work. conclusions  Patients with Addison’s disease under replacement therapy with cortisone acetate and fludrocortisone have reduced general health perception and vitality, and increased fatigue. Female patients reported reduced physical function, which might be due to adrenal androgen depletion. Mental health seems more influenced by concomitant endocrine diseases, but mental fatigue might be a specific feature in adrenal failure. The patient population is heterogeneous, with normal findings in a substantial proportion but markedly reduced subjective health status and working ability in many others. Thus, there might be potential for further refinement of replacement therapy.