Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Addison Disease: HELP
Articles by David J. Torpy
Based on 8 articles published since 2010
(Why 8 articles?)

Between 2010 and 2020, David J. Torpy wrote the following 8 articles about Addison Disease.
+ Citations + Abstracts
1 Review An Update on Addison's Disease. 2019

Barthel, Andreas / Benker, Georg / Berens, Kai / Diederich, Sven / Manfras, Burkhard / Gruber, Matthias / Kanczkowski, Waldemar / Kline, Greg / Kamvissi-Lorenz, Virginia / Hahner, Stefanie / Beuschlein, Felix / Brennand, Ana / Boehm, Bernhard O / Torpy, David J / Bornstein, Stefan R. ·Medicover, Bochum, Germany. · Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany. · Medicover, Berlin-Mitte, Germany. · Medicover, Ulm and Neu-Ulm, Germany. · University of Calgary, Calgary, AB,Canada. · Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom. · Department of Medicine I, Würzburg University Hospital, Würzburg, Germany. · Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, University Hospital, Zürich, Switzerland. · Lee Kong Chian School of Medicine, NTU Nanyang Technological University, Singapore, Singapore. · Endocrine and Metabolic Unit, Royal Adelaide Hospital, University of Adelaide, Adelaide SA, Australia. ·Exp Clin Endocrinol Diabetes · Pubmed #30562824.

ABSTRACT: Addison's disease - the traditional term for primary adrenal insufficiency (PAI) - is defined as the clinical manifestation of chronic glucocorticoid- and/or mineralocorticoid deficiency due to failure of the adrenal cortex which may result in an adrenal crisis with potentially life-threatening consequences. Even though efficient and safe pharmaceutical preparations for the substitution of endogenous gluco- and mineralocorticoids are established in therapy, the mortality in patients with PAI is still increased and the health-related quality of life (HRQoL) is often reduced.PAI is a rare disease but recent data report an increasing prevalence. In addition to the common "classical" causes of PAI like autoimmune, infectious, neoplastic and genetic disorders, other iatrogenic conditions - mostly pharmacological side effects (e. g., adrenal haemorrhage associated with anticoagulants, drugs affecting glucocorticoid synthesis, action or metabolism and some of the novel anti-cancer checkpoint inhibitors) are contributing factors to this phenomenon.Due to the rarity of the disease and often non-specific symptoms at least in the early stages, PAI is frequently not considered resulting in a delayed diagnosis. Successful therapy is mainly based on adequate patient education as a cornerstone in the prevention and management of adrenal crisis. A focus of current research is in the development of pharmacokinetically optimized glucocorticoid preparations as well as regenerative therapies.

2 Article Acute illness in patients with concomitant Addison's disease and type 1 diabetes mellitus: Increased incidence of hypoglycaemia and adrenal crises. 2020

Mortimer, Brienna / Naganur, Vaidehi Dhirendra / Satouris, Paul / Greenfield, Jerry R / Torpy, David J / Rushworth, R Louise. ·School of Medicine, The University of Notre Dame, Sydney, Australia. · Department of Endocrinology, St Vincent's Hospital, Darlinghurst and St Vincent's Clinical School, University of NSW, Sydney. · Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia. ·Clin Endocrinol (Oxf) · Pubmed #32396991.

ABSTRACT: BACKGROUND: Patients with Addison's disease (AD) and comorbid type 1 diabetes mellitus (T1DM) are at increased risk of certain acute metabolic disorders relative to patients with one of these conditions only. The reasons for this are unknown. METHODS: All attendances for acute illness by AD patients at the emergency department of a Sydney hospital between 2000 and 2017 were reviewed. Physiological parameters and illness management strategies were compared between AD patients, those with T1DM and AD combined, and a control group of patients with T1DM. RESULTS: There were 39 presentations for an acute medical illness by 20 non-diabetic AD (28 attendances) and 5 diabetic AD patients (11 presentations) and 40 attendances by 10 T1DM controls. In AD patients, 17 (43.6%) attendances were medically-diagnosed adrenal crises (AC) (63.6% [n=7] in diabetic AD and 35.7% [n=10] in non-diabetic AD). This corresponded to an estimated incidence of 12.5 AC/100 patient years (PY) for diabetic AD patients compared to 4.7 AC/100PY for non-diabetic AD patients (p<0.05). Glucocorticoid stress doses preceded 61.5% (n=24) of all attendances. Patients who used stress doses had more presentations than those who did not (2.0±1.3 vs 1.2±0.5, p=0.01). Diabetic AD patients had a lower mean blood glucose level on presentation (5.6+/-3.9mmol/l) than the T1DM control sample (11.6+/-6.2mmol/l) p<0.001. No T1DM patients had hypoglycaemia in the 3.0-3.9 mmol/l range but 2 (18.2%) of the diabetic AD patients had presenting blood glucose levels in this category, (p<0.05). Hyperglycaemia was more common among T1DM control patients (62.5%, n=26) than diabetic AD patients (18.2%, n=2), p<0.01. CONCLUSION: AD patients with T1DM have a higher incidence of adrenal crisis (AC) and hypoglycaemia than non-diabetic AD patients, and a lower incidence of hyperglycaemia than those with T1DM alone. This information may be of value in counselling patients with T1DM and AD about AC and hypoglycaemia prevention.

3 Article Prehospital Management of Acute Addison Disease: Audit of Patients Attending a Referral Hospital in a Regional Area. 2019

Goubar, Thomas / Torpy, David J / McGrath, Shaun / Rushworth, R Louise. ·School of Medicine, Sydney, The University of Notre Dame, Darlinghurst, Australia. · Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, North Terrace, Adelaide, Australia. · John Hunter Hospital, New Lambton, Australia. ·J Endocr Soc · Pubmed #31723718.

ABSTRACT: Context: Adrenal crisis (AC) causes morbidity and mortality in patients with Addison disease [primary adrenal insufficiency (PAI)]. Patient-initiated stress dosing (oral or parenteral hydrocortisone) is recommended to avert ACs. Although these should be effective, the continued incidence of ACs remains largely unexplained. Methods: Audit of all attendances between 2000 and 2017 of adult patients with treated PAI to one large regional referral center in New South Wales, Australia. Measurements were those taken on arrival at hospital. Results: There were 252 attendances by 56 patients with treated PAI during the study period. Women comprised 60.7% (n = 34) of the patients. The mean age of attendees was 53.7 (19.6) years. Nearly half (45.2%, n = 114) of the patients had an infection. There were 61 (24.2%) ACs diagnosed by the treating clinician. Only 17.9% (n = 45) of the hospital presentations followed any form of stress dosing. IM hydrocortisone was used prior to presentation 7 (2.8%) attendances only. Among patients with a clinician-diagnosed AC, only 32.8% (n = 20) had used stress dosing before presentation. Vomiting was reported by 47.6% (n = 120) of the patients but only 33 (27.5%) of these attempted stress dosing and 5 patients with vomiting used IM hydrocortisone. The number of prior presentations was an independent predictor of use of stress doses [1.05 (1.01, 1.09)]. Conclusion: Dose-escalation strategies are not used universally or correctly by unwell patients with PAI; many patients do not use IM or subcutaneous hydrocortisone injections. Previous hospital treatment increases the likelihood of stress dosing, and hospital attendance offers the opportunity for reinforcement of prevention strategies.

4 Article Adrenal Crises in Children: Perspectives and Research Directions. 2018

Rushworth, R Louise / Torpy, David J / Stratakis, Constantine A / Falhammar, Henrik. ·School of Medicine, Sydney, The University of Notre Dame, Darlinghurst, New South Wales, Australia. · Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia. · Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA. · Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden. · Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. · Menzies School of Health Research and Royal Darwin Hospital, Tiwi, Northwest Territories, Australia. ·Horm Res Paediatr · Pubmed #29874655.

ABSTRACT: Adrenal crises (AC) are life-threatening physiological disturbances that occur at a rate of 5-10/100 patient years in patients with adrenal insufficiency (AI). Despite their seriousness, there is a paucity of information on the epidemiology of AC events in the paediatric population specifically, as most investigations have focused on AI and ACs in adults. Improved surveillance of AC-related morbidity and mortality should improve the delineation of AC risk overall and among different subgroups of paediatric patients with AI. Valid incidence measures are essential for this purpose and also for the evaluation of interventions aimed at reducing adverse health outcomes from ACs. However, the absence of an agreed AC definition limits the potential benefit of research and surveillance in this area. While approaches to the treatment and prevention of ACs have much in common across the lifespan, there are important differences between children and adults with regards to the physiological, psychological, and social milieu in which these events occur. Education is considered to be an essential element of AC prevention but studies have shown that ACs occur even among well-educated patients, suggesting that new strategies may be needed. In this review, we examine the current knowledge regarding AC events in children with AI; assess the existing definitions of an AC and offer a new definition for use in research and the clinic; and suggest areas for further investigation that are aimed at reducing the incidence and health impact of ACs in the paediatric age group.

5 Article Hospitalisation in Children with Adrenal Insufficiency and Hypopituitarism: Is There a Differential Burden between Boys and Girls and between Age Groups? 2017

Rushworth, R Louise / Chrisp, Georgina L / Dean, Benjamin / Falhammar, Henrik / Torpy, David J. ·School of Medicine, Sydney, The University of Notre Dame, Darlinghurst, New South Wales, Australia. · Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden. · Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. · Menzies School of Health Research and Royal Darwin Hospital, Tiwi, Northwest Territories, Australia. · Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia. ·Horm Res Paediatr · Pubmed #28898882.

ABSTRACT: BACKGROUND/AIMS: To determine the burden of hospitalisation in children with adrenal insufficiency (AI)/hypopituitarism in Australia. METHODS: A retrospective study of Australian hospitalisation data. All admissions between 2001 and 2014 for patients aged 0-19 years with a principal diagnosis of AI/hypopituitarism were included. Denominator populations were extracted from national statistics datasets. RESULTS: There were 3,779 admissions for treatment of AI/hypopituitarism in patients aged 0-19 years, corresponding to an average admission rate of 48.7 admissions/million/year. There were 470 (12.4%) admissions for an adrenal crisis (AC). Overall, admission for AI/hypopituitarism was comparable between the sexes. Admission rates for all AI, hypopituitarism, congenital adrenal hyperplasia (CAH), and "other and unspecified causes" of AI were highest among infants and decreased with age. Admissions for primary AI increased with age in both sexes. Males had significantly higher rates of admission for hypopituitarism. AC rates differed by both sex and age group. CONCLUSION: This nationwide study of the epidemiology of hospital admissions for a principal diagnosis of AI/hypopituitarism shows that admissions generally decreased with age; males had higher rates of admission for hypopituitarism; females had higher rates of admission for CAH and "other and unspecified causes" of AI; and AC incidence varied by age and sex. Increased awareness of AI and AC prevention strategies may reduce some of these admissions.


Torpy, David J. · ·Endocr Pract · Pubmed #27682350.

ABSTRACT: -- No abstract --

7 Article Recurrent nocturnal hypoglycaemia as a cause of morning fatigue in treated Addison's disease--favourable response to dietary management: a case report. 2015

Petersen, Kristina S / Rushworth, R Louise / Clifton, Peter M / Torpy, David J. ·Dietitian, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5000, Australia. Kristina.Petersen@unisa.edu.au. · School of Medicine, Sydney, The University of Notre Dame, 60 Oxford St., Darlinghurst, NSW 2010, Australia. louise.rushworth@nd.edu.au. · School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5000, Australia. Peter.Clifton@unisa.edu.au. · Endocrine and Metabolic Unit, Royal Adelaide Hospital, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia. David.Torpy@health.sa.gov.au. ·BMC Endocr Disord · Pubmed #26500000.

ABSTRACT: BACKGROUND: Addison's disease, or primary adrenal insufficiency, is often associated with reduced well-being and fatigue despite use of currently recommended adrenal hormone replacement. Hypoglycaemia is a known manifestation of glucocorticoid deficiency, but is generally considered rare in adults and not relevant to troubling ongoing symptoms in patients with Addison's disease. CASE PRESENTATION: A 43 year old woman with a three year history of Addison's disease complained of severe morning fatigue and headaches, despite standard glucocorticoid replacement therapy in the form of thrice daily hydrocortisone and mineralocorticoid replacement with fludrocortisone. Alternative glucocorticoid replacement regimens and the addition of dehydroepiandrosterone replacement therapy had no effect. Nocturnal hypoglycaemia was suspected and a 4-day continuous glucose monitor system (CGMS) revealed hypoglycaemia (interstitial glucose < 2.2 mmol/L) between 0200-0400 h on 3 of 4 days. The patient was counselled to take an evening snack designed to ensure slow absorption of ingested carbohydrates. Nocturnal hypoglycaemia was then absent on follow up CGMS assessment. The patient noted a marked symptomatic improvement in morning symptoms, but with persistent fatigue during the day. CONCLUSION: Currently, the best strategy for control of non-specific symptoms in treated Addison's disease is unknown, but it may be that investigation for hypoglycaemia and treatment, where necessary, could assist some sufferers to achieve improved wellbeing. A systematic study of this phenomenon in Addison's disease is required.

8 Article Continuous subcutaneous hydrocortisone infusion therapy in Addison's disease: a randomized, placebo-controlled clinical trial. 2014

Gagliardi, Lucia / Nenke, Marni A / Thynne, Tilenka R J / von der Borch, Jenny / Rankin, Wayne A / Henley, David E / Sorbello, Jane / Inder, Warrick J / Torpy, David J. ·Endocrine and Metabolic Unit (L.G., M.A.N., T.R.J.T., D.J.T.), Royal Adelaide Hospital, Adelaide 5000, Australia · School of Medicine (L.G., M.A.N., D.J.T.), University of Adelaide 5000, Australia · Diabetes Centre (J.v.d.B.), Royal Adelaide Hospital, Adelaide 5000, Australia · Department of Chemical Pathology (W.A.R.), SA Pathology, Adelaide 5000, Australia · Department of Endocrinology and Diabetes (D.E.H.), Sir Charles Gairdner Hospital, Perth 6009, Australia · School of Medicine and Pharmacology (D.E.H.), University of Western Australia, Perth 6009, Australia · Department of Diabetes and Endocrinology (J.S., W.J.I.), Princess Alexandra Hospital, Brisbane 4102, Australia · and School of Medicine (W.J.I.), University of Queensland, Brisbane 4072, Australia. ·J Clin Endocrinol Metab · Pubmed #25127090.

ABSTRACT: CONTEXT: Patients with Addison's disease (AD) report impaired subjective health status (SHS). Since cortisol exhibits a robust circadian cycle that entrains other biological clocks, impaired SHS may be due to the noncircadian cortisol profile achieved with conventional glucocorticoid replacement. Continuous subcutaneous hydrocortisone infusion (CSHI) reproduces a circadian cortisol profile, but its effects on SHS have not been objectively evaluated. OBJECTIVE: The aim of this study was to determine the effect of CSHI on SHS in AD. SETTING AND DESIGN: This was a multicentre, double-blind, placebo-controlled trial of CSHI vs oral glucocorticoid therapy. Participants received in random order 4 weeks of: CSHI and oral placebo, and subcutaneous placebo and oral hydrocortisone, separated by a 2-week washout period. SHS was assessed using the Short-Form 36 (SF-36), General Health Questionnaire (GHQ-28), Fatigue Scale (FS), Gastrointestinal Symptom Rating Scale (GSRS); and Addison's Quality of Life Questionnaire (AddiQoL). Participants were asked their (blinded) treatment preference. Twenty-four hour urine free cortisol (UFC) and diurnal salivary cortisol collections compared cortisol exposure during each treatment. RESULTS: Ten participants completed the study. Baseline SHS scores (mean ± SE) were consistent with mild impairment: SF-36 physical component summary 48.4 (± 2.4), mental component summary 53.3 (± 3.0); GHQ-28 18.1 (± 3.3); GSRS 3.7 (± 1.6), and AddiQoL 94.7 (± 3.7). FS was similar to other AD cohorts 13.5 (± 1.0) (P = 0.82). UFC between treatments was not different (P = 0.87). The salivary cortisol at 0800 h was higher during CSHI (P = 0.03), but not at any other time points measured. There was no difference between the treatments in the SHS assessments. Five participants preferred CSHI, four oral hydrocortisone, and one was uncertain. CONCLUSIONS: Biochemical measurements indicate similar cortisol exposure during each treatment period, although a more circadian pattern was evident during CSHI. CSHI does not improve SHS in AD with good baseline SHS. This casts some doubt on the potential benefit of circadian cortisol delivery on SHS in AD.