SUN-411 Adrenal Crises And Quality Of Life In Patients Post Bilateral Adrenalectomy Versus Autoimmune Adrenalitis

Abstract Disclosure: A. Bancos: None. Y. Hleibiehova: None. R. Gregg garcia: None. N. Genere: None. S. Achenbach: None. E. Atkinson: None. S. Mahrokhian: None. A. Vaidya: None. I. Bancos: None. Background: Bilateral adrenalectomy (BLA) is a seldomly performed treatment for hypercortisolism, pheochromocytoma, or metastatic adrenal disease that leads to permanent primary adrenal insufficiency (PAI). PAI due to BLA is seldomly studied independently of PAI due to autoimmune adrenalitis (AA), despite differences in onset of disease, and neither group has large-scale data focusing on factors that impact quality of life (QOL) post-PAI. Furthermore, no study to date has compared patients’ burden of disease or number of adrenal crises in patients with PAI due to BLA versus patients with PAI due to AA. Methods: We conducted a dual-center, cross-sectional study of adults with PAI due to AA or BLA, 2022-2025. All participants completed a questionnaire on symptoms, management, adrenal crises, and an adrenal insufficiency-specific QoL survey (AddiQoL). Outcomes included AddiQoL scores and self-reported adrenal crises. Pearson correlations were used to explore relationships with AddiQoL scores. Logistic regression models were used to examine associations with having an adrenal crisis in the past year. Results: Of the 343 participants, 203 had AA (median age of 54 years, IQR 42-67, 72% women) and 140 had BLA (median age of 57 years, IQR 44-67, 76% women). Median duration of PAI was similar for AA and BLA cohorts (13 vs 10 years, P=0.205). Patients with AA and BLA were treated with hydrocortisone (84% vs 78%), prednisone (19% vs 21%), or dexamethasone (1% vs 1%), with a similar median daily hydrocortisone equivalent dose (21 mg vs. 20 mg, P=0.259). No group differences in availability of glucocorticoid injections (85% vs 83%) and medical alert bracelet (81 vs 83%) were reported. AddiQoL scores were similar between patients with AA and BLA (median 84 vs 83, P=0.984). AddiQoL score was better in older patients (R=0.16, P=0.003), men (R=0.17, P=0.002), daily hydrocortisone ≤ 20 mg/day (R=0.11, P=0.04), and those with supportive health insurance (R=0.20, P<0.001). Patients with AA reported a higher number of adrenal crises since diagnosis (median of 0.1/person-years, IQR 0-0.4 vs 0/person-years, IQR 0-0.3, P=0.046), as well as in the last year (25% vs 13%, P=0.022), compared to patients with BLA. In a multivariable model of age, sex, glucocorticoid dose, availability of glucocorticoid injection/medical bracelet, type of PAI, and number of symptoms, patients with AA (OR 2.1, 95%CI 1.0-4.4) and those with more symptoms (OR 1.2, 95% CI 1.1-1.3) were more likely to have an adrenal crisis within the last year. Conclusion: We found no differences in the QoL scores, burden of disease, symptoms, or management of patients with AA and BLA. However, patients with AA reported more adrenal crises both overall and within the last year of assessment. Presentation: Sunday, July 13, 2025