1214 - Clinical characteristics of patients with adrenal insufficiency presenting fever

Background: The aim of the present study is to analyze the clinical characteristics of adrenal insufficiency patients presenting fever.

Methods: A single-center retrospective study was conducted in an 846-bed tertiary hospital in South Korea. All hospitalized adult patients (age ≥19 years) who diagnosed with adrenal insufficiency between March 1, 2018 and June 30, 2019 were recruited. Only the first event per patient was included and patients were excluded if they: (1) had proven structural problems with adrenal or pituitary gland, (2) had a history of chemotherapy within 6 months prior to the diagnosis of adrenal insufficiency, and (3) had other medical conditions which may cause fever. 

Results: A total of 150 cases were included: 45 (30.0%) had fever and 105 (70.0%) did not have fever at the time of diagnosis of adrenal insufficiency. The proportion of female patients was  lower in patients with fever compared to those without fever (44.4% vs. 67.6%, P =0.008). In addition, patients with fever were diagnosed at 13.98 ± 14.51 days, which was later than 6.47 ± 6.91 of patients without fever (P < 0.001). Higher proportion of patients with fever had history of surgical procedure within 6 months (33.3% vs. 11.4%, P =0.001) and antibiotic usage at the time of diagnosis (80.0% vs. 17.1%, P < 0.001) compared to those without fever. Among clinical manifestations, general weakness (91.1% vs. 66.7%, P =0.002), headache (15.6% vs. 4.8%, P =0.044), and cough (17.8% vs. 4.8%, P = 0.022) were more frequently observed in patients with fever. There were no significant differences in clinical outcomes between two groups. According to the multivariate analysis, female sex (OR =0.32, 95% CI: 0.12–0.86, P = 0.024) lowered the risk for adrenal insufficiency with fever. In comparison, history of surgical procedure within 6 months (OR = 4.35, 95% CI: 1.23–15.39, P =0.023), general weakness (OR = 7.21, 95% CI: 1.71–30.37, P =0.007), and cough (OR = 17.29, 95% CI: 1.09–274.92, P =0.043) were significantly associated with adrenal insufficiency with fever.Table. Risk factors for adrenal insufficiency with fever using a multivariable logistic regression model


Conclusion: Approximately 30% of adrenal insufficiency presented fever. In patients with adrenal insufficiency and male sex, history of surgical procedure within 6 months, general weakness, and cough may be associated with presenting fever.