Clinical characteristics of acute adrenal insufficiency in emergency patients: an analysis of data in Lhasa, Xizang Autonomous Region of China.

IF 3.2 3区医学 Q1 EMERGENCY MEDICINE

World journal of emergency medicine Pub Date : 2025-09-01 DOI:10.5847/wjem.j.1920-8642.2025.085

Guiying Dong, Jianbo Yu, Lobsang Chodron, Tenzin Chodron, Peiliang Gao, Xueying Fu, Jihong Zhu, Zhenzhong Yang, Lobsang Cering

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引用次数: 0

Abstract

Background: The nonspecific clinical presentation of adrenal insufficiency (AI) frequently leads to misdiagnosis, often as psychiatric or gastrointestinal disorders. AI is classified anatomically as primary AI (PAI), secondary AI (SAI), or tertiary AI (TAI). Without timely recognition, progression to adrenal crisis (AC) can result in life-threatening outcomes. This study aimed to systematically analyze the clinical features, etiologies, and outcomes of AI in Lhasa's emergency population to improve diagnostic accuracy and optimize clinical management.

Methods: A retrospective analysis of emergency department admissions from January 2020 to August 2024 at People's Hospital of Xizang Autonomous Region was conducted. AI diagnoses were identified via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes from electronic health records (EHR). Patients were grouped into incipient AC (IAC) or AC cohorts based on hemodynamic status. Demographic profiles, etiologies, clinical presentations, and laboratory results were analyzed.

Results: Forty-three AI patients were identified. The population-standardized admission rate for AI increased from 9 to 16 per million person-years, with PAI cases doubling during this period. Adrenal tuberculosis (58.1%) and adrenal hematoma (18.6%) were the leading etiologies. Compared to the IAC group, the AC group demonstrated lower systolic blood pressure (SBP) (P=0.001) and diastolic blood pressure (DBP) (P<0.001); higher neutrophil count (P=0.048), eosinophil count (P=0.044), CRP (P=0.004), blood urea nitrogen (BUN) (P=0.007); lower sodium (P<0.001) and glucose levels (P=0.001). The hospital stay was longer in the AC group (20 d vs. 14 d; P<0.001).

Conclusion: AI incidence is rising in high-altitude regions, with adrenal tuberculosis remaining the most common cause. AC is associated with increased inflammatory responses, hemodynamic instability, and metabolic disturbances. Targeted interventions are required to improve outcomes.

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急诊患者急性肾上腺功能不全的临床特点：对中国西藏自治区拉萨市资料的分析

背景：肾上腺功能不全（AI）的非特异性临床表现经常导致误诊，常被误诊为精神疾病或胃肠道疾病。人工智能在解剖学上分为初级人工智能（PAI）、二级人工智能（SAI）和三级人工智能（TAI）。如果不及时识别，进展到肾上腺危机（AC）可能导致危及生命的结果。本研究旨在系统分析拉萨市急诊人群AI的临床特征、病因及转归，以提高诊断准确性和优化临床管理。方法：回顾性分析西藏自治区人民医院2020年1月至2024年8月急诊科收治病例。通过电子健康记录（EHR）中的国际疾病分类第十版临床修改（ICD-10-CM）代码确定人工智能诊断。根据血流动力学状态将患者分为早期AC （IAC）组和AC组。分析了人口统计资料、病因、临床表现和实验室结果。结果：共发现AI患者43例。AI的人口标准化入院率从每百万人年9例增加到16例，PAI病例在此期间翻了一番。肾上腺结核（58.1%）和肾上腺血肿（18.6%）是主要病因。与IAC组比较，AC组收缩压（SBP）（P=0.001）、舒张压（DBP）（PP=0.048）、嗜酸性粒细胞计数（P=0.044）、CRP （P=0.004）、尿素氮（BUN）（P=0.007）均明显降低；低钠（PP=0.001）。AC组住院时间更长（20 d vs 14 d）；结论：高海拔地区AI发病率呈上升趋势，肾上腺结核仍是最常见的原因。AC与炎症反应增加、血流动力学不稳定和代谢紊乱有关。需要有针对性的干预措施来改善结果。

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来源期刊

World journal of emergency medicine EMERGENCY MEDICINE-

CiteScore

2.50

自引率

28.60%

发文量

671

期刊介绍： The journal will cover technical, clinical and bioengineering studies related to multidisciplinary specialties of emergency medicine, such as cardiopulmonary resuscitation, acute injury, out-of-hospital emergency medical service, intensive care, injury and disease prevention, disaster management, healthy policy and ethics, toxicology, and sudden illness, including cardiology, internal medicine, anesthesiology, orthopedics, and trauma care, and more. The journal also features basic science, special reports, case reports, board review questions, and more. Editorials and communications to the editor explore controversial issues and encourage further discussion by physicians dealing with emergency medicine.