Adrenal crisis: incidence, clinical presentation and risk factors in patients with Addison's disease.

IF 2.9 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Pub Date : 2025-07-30 DOI:10.1007/s12020-025-04242-7

Alberto Scala, Marianna Torchio, Fabio Presotto, Caterina Mian, Filippo Ceccato, Carla Scaroni, Corrado Betterle, Chiara Sabbadin

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引用次数: 0

Abstract

Purpose: Adrenal crisis (AC) is the most severe manifestation of primary adrenal insufficiency (PAI) and is associated with high mortality. Its insidious presentation often leads to a delayed diagnosis and treatment. In this study, we aim to determine the incidence, characteristics, precipitating and predisposing factors for AC.

Methods: A total of 132 patients with PAI were evaluated retrospectively. Patients' features and information on their previous AC were collected through a structured interview and clinical documentation, supplied by patients or retrieved from archives of the Hospitals of Padova and Venice-Mestre.

Results: Among enrolled patients, 95 (71.9%) were females, the mean age was 48.8 ± 13.5 years, and the mean PAI duration was 14.9 ± 11.8 years. The most frequent cause of PAI was autoimmune adrenalitis (92.4%), mainly associated with other autoimmune comorbidities. The 65.9% of patients experienced at least one AC, with an incidence of 10.5/100 patient-years. A significant number of AC (116/206) occurred in patients already undergoing glucocorticoid therapy. The most frequent features of AC were fatigue (96%), gastrointestinal symptoms (85%), and hyponatremia (77%). The most frequent triggers were vomiting and/or diarrhoea (65%), infections (38%), and emotional stress (29%). Patients with more autoimmune comorbidities and those with premature ovarian insufficiency (POI) were at higher risk of AC (p < 0.02).

Conclusions: AC is still a frequent complication of patients with PAI, particularly in those with additional autoimmune comorbidities or with POI. Awareness of AC among clinicians, patients, and care-givers is crucial for the prevention, recognition, and proper treatment of this life-threatening complication.

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肾上腺危机：艾迪生病患者的发病率、临床表现和危险因素。

目的：肾上腺危象（AC）是原发性肾上腺功能不全（PAI）最严重的表现，死亡率高。其隐匿的表现往往导致延误诊断和治疗。本研究旨在探讨PAI的发病率、特点、诱发因素及易感因素。方法：对132例PAI患者进行回顾性分析。通过结构化访谈和临床文件收集患者的特征和既往AC信息，这些文件由患者提供或从帕多瓦医院和威尼斯-梅斯特医院的档案中检索。结果：入组患者中，女性95例（71.9%），平均年龄48.8±13.5岁，平均PAI病程14.9±11.8年。PAI最常见的原因是自身免疫性肾上腺炎（92.4%），主要与其他自身免疫性合并症相关。65.9%的患者至少经历一次AC，发生率为10.5/100患者-年。大量AC（116/206）发生在已经接受糖皮质激素治疗的患者中。AC最常见的特征是疲劳（96%）、胃肠道症状（85%）和低钠血症（77%）。最常见的诱发因素是呕吐和/或腹泻（65%）、感染（38%）和情绪压力（29%）。有更多自身免疫性合并症和卵巢功能不全（POI）的患者发生AC的风险更高(p)。结论：AC仍然是PAI患者的常见并发症，特别是那些有其他自身免疫性合并症或POI的患者。临床医生、患者和护理人员对AC的认识对于预防、识别和适当治疗这种危及生命的并发症至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.