Introduction: Adrenal insufficiency (AI) is a clinical entity frequently unrecognized due to its nonspecific symptoms. It may lead to increased risk of systemic illness in conditions that precipitate shock, such as hypovolemia. The incidence of AI and its effects in patients with upper gastrointestinal non-variceal bleeding (UGINVB) is unknown. We aimed to determine the impact on the clinical outcomes of patients presenting with UGINVB in AI vs non-AI population. Methods: A retrospective cohort study was done using the United States 2013 National Inpatient Sample, the largest publicly available inpatient database in the United States. All patients with ICD-9 CM codes for a primary diagnosis of UGINVB were included. No exclusion criteria were used. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity measured by intensive care unit (ICU) admission, shock, multi-organ dysfunction (MOD) and malnutrition; resource utilization measured by abdominal ultrasound (US), abdominal CT scan (ACT), length of hospital stay (LOS), total parenteral nutrition (TPN) use, total hospitalization charges (TOC), esophagogastroduodenoscopy (EGD) and colonoscopy. Patients were classified as AI or non-AI diagnosis based on ICD-9 CM codes. Odds ratios and means were calculated using multivariate regression analysis, after being adjusted for age, sex, race, Charlson Comorbidity Index, median income in the patient's zip code, hospital region, rural location, size and teaching status. Results: A total of 138,700 patients with UGINVB were included. Mean age was 64.3 years and 44.9% were female. 470 (0.34%) had AI diagnosis. In-hospital mortality rate was 1.74% overall, 4.2% in AI patients and 1.7% in non-AI patients. Adjusted odds ratios, means and P values are shown in Table 1. On multivariate analysis, patients with AI had increased mortality (OR 2.64, 95% CI 0.92 - 7.58; P=0.07) compared to the non-AI population. Regarding morbidity, ICU admission, shock, malnutrition and MOD were more common in AI patients. Resource utilization, total charges, LOS, and TPN use were higher in the AI group; the use of ACT/US and need for EGD/colonoscopy were the same in both groups.Table: Table. Odds Ratio for mortality, morbidity and resource utilization in adrenal insufficiency vs non-adrenal insufficiency patients with upper gastrointestinal non-variceal bleeding.Conclusion: Adrenal insufficiency is associated with increased morbidity in patients admitted with UGINVB. These patients present an increase in resource hospitalization, particularly hospitalization charges, length of stay and TPN use. Special attention needs to be taken in these population due to worse overall outcomes.