The ISAQ Score Does Not Predict Adrenal Crisis in Patients with Primary Adrenal Insufficiency

Abstract

Objective This study aimed to investigate the ability of the immune system assessment questionnaire (ISAQ) to predict adrenal crisis (AC) and infectious events in patients with primary adrenal insufficiency (PAI). Design This was a prospective single-centre study over three years. Methods Patients answered the ISAQ at baseline and were seen every 4–6 months in the endocrine outpatient clinic. At each visit previous infectious periods which required an increase in daily glucocorticoid dosage and AC were reported and documented. Seventy-five patients with PAI (53 women; 43 patients with autoimmune PAI, 20 patients with salt-wasting congenital adrenal hyperplasia and 12 patients who underwent bilateral adrenalectomy) were analysed. Due to the COVID-19 pandemic and consecutive lockdown measures, the data were analysed separately for March 2018 to March 2020 (period 1), and March 2020 to March 2021 (period 2). Results During period 1 the ISAQ score significantly correlated with the number of reported infectious events (r=0.351; p<0.01), but not during period 2 (r=0.059, p=0.613), in which the number of infectious events per patient-year significantly decreased (1.1±0.1 vs 0.4±0.1; p<0.001). The frequency of AC decreased from 8.8 to 2.4 per 100 patient-years between the two study periods. The ISAQ score was not different between patients with or without AC. Conclusions The ISAQ score does not identify patients prone to ACs. The COVID-19 pandemic and consecutive lockdown measures significantly diminished the frequency of infectious events and ACs.

Addison’s Disease: Diagnosis and Management Strategies

“… 83 Interestingly, one study (N = 75 patients with AD) evaluated via ISAQ (immune system assessment questionnaire) the accuracy of predicting an adrenal crisis: ISAQ score was similar pre-pandemic versus pandemic, while the rate of adrenal crisis decreased from 8.8 to 2.4/100 patient-years due to new (pandemic) regulations. 84 A significant disease burden is due to frequent hospitalizations and presentations at hospital. A population-based study from Alberta included patients with AI; the study pointed out that the average number of medical visits compared with regular controls for their endocrine condition was 17.8 per year (as outpatients), and 2.3 per year for presentation as an emergency (this being 3–4 times higher than the average resident population) 85 ( Table 4 ).…”

Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: the ICARO tool

“…Patient-reported outcome measures (PROMs) like self-reported questionnaires are gaining momentum, especially in patients living with rare disorders, and their routine use in clinical practice has been shown to improve patient satisfaction with their care, management, and quality of life [62]. The aforementioned ISAQ was recently tested in patients with PAI, with unsatisfactory results: this may have been due to the nature of the questionnaire, which was originally designed for severely immunocompromised patients [63]. In contrast, the ICARO questionnaire is derived from both the GNC questionnaire and ISAQ and has been specifically adapted for outpatients.…”

Susceptibility and characteristics of infections in patients with glucocorticoid excess or insufficiency: The ICARO tool

“…It is the first development of an objective tool to quantify the burden of infectious disease in endocrine patients. The aforementioned ISAQ was recently tested in patients with PAI, with unsatisfactory results: this may have been due to the nature of the questionnaire, which was originally designed for severely immunocompromised patients [61]. In contrast, the ICARO questionnaire is derived from both the GNC questionnaire and ISAQ and has been specifically adapted for outpatients.…”