SAT280 Burden Of Disease and Quality Of Life In Patients After Bilateral Adrenalectomy Versus Autoimmune Adrenalitis: A Cross-sectional Survey Study
Authors: Garcia Raul Gregg , Bancos Irina 
Published: October 2023

Abstract
Disclosure: R. Gregg Garcia: None. I. Bancos: None.
Background: Bilateral adrenalectomy (BLA) is a procedure with limited indications, such as bilateral pheochromocytomas and certain cases of Cushing syndrome. Impaired quality of life (QoL) has been reported in patients with primary adrenal insufficiency (PAI) due to autoimmune adrenalitis (AA). We hypothesized that, when compared to AA, patients post-BLA experience worse QoL due to sequelae of Cushing syndrome or pheochromocytoma. Objective: To compare the QoL and burden of disease in patients with PAI due to BLA versus AA. Methods: A cross-sectional study of adults with PAI due to BLA or AA, August 15 - November 26, 2022. Patients were excluded if PAI was diagnosed within one year from the enrollment date or if active malignancy was present. Participants completed a questionnaire about symptoms, burden of disease, adrenal crisis, and QoL (AddiQoL). Results: Of 120 patients with PAI, 49 (41%) had BLA, and 71 (59%) had AA. Median age was 52 years (range 23-80), without subgroup differences, but a higher proportion of women in the post-BLA vs the AA group (86% vs 69%, p=0.04). Reasons for BLA were Cushing syndrome (44, 90%) and bilateral pheochromocytomas (5, 10%). Duration of PAI was higher in patients with AA (median 12 vs 7 years post-BLA, p=0.02). The majority of patients reported wearing a medical bracelet (82%), having injectable glucocorticoid (90%), and comfort injecting (61%), without subgroup differences. Total daily hydrocortisone dose was higher in patients with AA vs patients post-BLA (mean of 23 mg vs 20 mg, p=0.03). A total of 26 (22%) patients reported at least one adrenal crisis within the last year, with a greater proportion in the post-BLA group (33% vs 14% in AA, p=0.02). No subgroup differences were noted in risk factors for adrenal crisis development, such as hydrocortisone equivalent dose, type of glucocorticoid therapy, duration of PAI, having a medic alert bracelet and injectable glucocorticoids, comfort injecting, or physical activity. Compared to AA, patients post-BLA had a similar QoL (median AddiQoL score 86 vs 84, p-value 0.72). Duration of PAI was not associated with QoL. Physical activity ≥3 times/week was associated with a better QoL (median AddiQoL score 90 vs 80 in those with lower level of physical activity, p=0.001); no subgroup differences in physical activity ≥3 times/week were found (57% in BLA vs 62% in AA, p=0.59). Since the initial diagnosis of PAI, more patients with AA reported that PAI was “harder” to manage (23% vs 6% post-BLA, p-value 0.04), with most patients reporting that management was easier (52% in AA and 63% in BLA) or not different (25% in AA and 31% in BLA). Conclusions: Despite a higher prevalence of adrenal crisis, more patients with BLA vs AA found PAI easier to manage. Moreover, patients with BLA and AA had a similar level of comfort and education managing PAI, similar QoL, and engaged in similar levels of physical activity, despite history of Cushing syndrome.
Presentation: Saturday, June 17, 2023