Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Data on survival and mortality in Addison's disease (AD) are contradictory: some studies suggest a mortality rate two times higher than in the general population, but this is not consistently reported in other studies. METHODS: We evaluated survival and mortality in 1,826 Italian adult patients with AD of different etiologies, collected from 1947 to 2024 across 30 Endocrine Units. These outcomes were compared to those of the age- and sex-matched Italian reference population using a standardized mortality ratio (SMR) in a subgroup of 1,575 cases. RESULTS: Sex and age adjusted survival analysis showed increased mortality in genetic AD, cancer-related-AD and cases with type 1 autoimmune polyendocrine syndrome (APS-1) compared to other etiologies. The SMR analysis demonstrated a significantly increased mortality risk of the overall patients with AD compared to the general population (SMR 1.34, p < 0.01). However, 4 etiologies presented survival similar to the general population: patients with type 2 or type 4 APS or isolated autoimmune AD (SMR 0.91, p = 0,57), vascular/post-tuberculosis AD (SMR 0.90, p = 0.69), bilateral adrenalectomy due to benign endocrine diseases (SMR 0.91. p = 0.64) and not defined AD (SMR 1.06, p = 0.93). These groups included 1,188 patients, representing 75.4% of the population. On the contrary, a significantly increased mortality risk compared to the general population was reported in the following 3 groups: patients with APS-1 (SMR 5.98, p < 0.01), genetic AD (SMR 5.09, p < 0.01), and cancer-related AD (SMR 4.64, p < 0.01), accounting for 387 patients (24.5%). CONCLUSION: Our study has shown that in adult patients with AD there is a large difference in survival and mortality based on the various etiological forms. In order to evaluate survival and mortality each form of AD must be considered separately and compared with an age- and sex-matched population.
Authors: Carlotta Keiko Vedolin, Chiara Sabbadin, Alessandro Mondin, Stefano Masiero, Mattia Barbot, Elisabetta Cavedon, Valentina Camozzi, Caterina Mian, Carla Scaroni, Fabio Presotto, Silvia Garelli, Carlo De Riva, Alessandro Delitala, Giorgio Radetti, Silvia Longhi, Carla Giordano, Valentina Guarnotta, Roberta Giordano, Antonella Meloni, Guido Di Dalmazi, Uberto Pagotto, Claudio Letizia, Giulia Marconcini, Fausto Bogazzi, Marco Cappa, Alessandra Fierabracci, Antonio Crinò, Anna Maria De Bellis, Mariluce Barrasso, Alberto Falorni, Valentina Morelli, Roberto Perniola, Francesca Pigliaru, Rosario Pivonello, Chiara Simeoli, Giuseppe Francia, Carolina Salerno, Donatella Capalbo, Giuseppe Picca, Antonio Stigliano, Malgorzata Gabriela Wasniewska, Filippo Ceccato, Corrado Betterle
Institutions: University of Padua, Azienda Ospedale - Università Padova, Ospedale dell' Angelo, University of Sassari, Azienda Ospedaliero Universitaria di Sassari, Ospedale di Bolzano, Azienda Sanitaria dell'Alto Adige, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo, University of Palermo, University of Turin, Ospedale Microcitemico, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, Sapienza University of Rome, University of Pisa, Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico, Link Campus University, Agostino Gemelli University Polyclinic, University of Campania "Luigi Vanvitelli", University of Perugia, IRCCS Istituto Auxologico Italiano, Ospedale Vito Fazzi, University of Cagliari, University of Naples Federico II, University of Verona, Federico II University Hospital, Ospedali Riuniti di Foggia, Azienda Ospedaliera Sant'Andrea, University of Messina
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
Funder: Università degli Studi di Padova
OpenAlex ID: W7162095494