Incidence and hospital outcomes of acute adrenal crisis in a Swisswide cohort study

Abstract Background Adrenal crises (AC) are life-threatening emergencies for which epidemiological data remain scarce, particularly in older adults. We analyzed nationwide data on AC-related hospitalizations in Switzerland between 2012 and 2022 to determine incidence, clinical outcomes, and predictors of adverse events, emphasizing differences across age groups and etiologies of adrenal insufficiency. Methods We conducted a nationwide retrospective cohort study using hospital discharge data linked to the national death registry. The primary outcome was the incidence of AC hospitalizations; secondary outcomes were a composite endpoint of in-hospital mortality, intensive care unit (ICU) admission and 30-day rehospitalization. We also assessed 1-year mortality and duration of hospital and ICU stay. Results We identified 2,302 AC-related hospitalizations with incidence increasing over time, peaking in patients 80 years, with the steepest rise in those with central adrenal insufficiency. Compared with matched controls, AC was associated with higher odds of the secondary composite outcome (IRR 1.60; 95% confidence interval CI1.48-1.73), primarily driven by ICU admissions (IRR 1.99; 95% CI 1.8-2.21). Patients with unspecified etiology of adrenal insufficiency had the highest odds for in-hospital mortality (IRR 1.8; 95% CI 1.48-2.19) and 1-year all-cause mortality (IRR 1.41; 95% CI 1.23-1.62). Key predictors of adverse outcomes included unspecified etiology of adrenal insufficiency, advanced age, male sex, arginine vasopressin deficiency, sepsis, and cancer. Conclusion In Switzerland, AC-related hospitalizations have increased over the past decade, primarily driven by an increase in central adrenal insufficiency, likely linked to expanding glucocorticoid and immunotherapy use. Older adults remain disproportionately vulnerable to adverse outcomes.