Large-Dose Glucocorticoid Induced Secondary Adrenal Insufficiency in Spinal Cord Injury.
10.5535/arm.2016.40.6.1033
- Author:
Soo Ho PARK
1
;
Kang Hee CHO
Author Information
1. Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea. sso224@cnuh.co.kr
- Publication Type:Original Article
- Keywords:
Spinal cord injuries;
Adrenal insufficiency;
Glucocorticoids
- MeSH:
Adrenal Insufficiency*;
Adrenocorticotropic Hormone;
Anorexia;
Dizziness;
Fatigue;
Glucocorticoids;
Humans;
Incidence;
Medical Records;
Rehabilitation Centers;
Retrospective Studies;
Spinal Cord Injuries*;
Spinal Cord*
- From:Annals of Rehabilitation Medicine
2016;40(6):1033-1039
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To investigate the incidence of adrenal insufficiency (AI) in patients with spinal cord injury (SCI) with symptoms similar to those of AI and to assess the relevance of AI and large-dose glucocorticoids in SCI. METHODS: The medical records of 228 patients who were admitted to the rehabilitation center after SCI from January 2014 to January 2016 were reviewed retrospectively. Twenty-nine of 228 patients had persistent symptoms suspicious for AI despite continuous care for more than 4 weeks. Therefore, adrenocorticotropic hormone (ACTH) stimulation tests were conducted in these 29 patients. RESULTS: Twelve of these 29 patients (41.4%) with SCI who manifested AI-like symptoms were diagnosed as having AI. Among these 29 patients, 15 patients had a history of large-dose glucocorticoid treatment use and the other 14 patients did not have such a history. Ten of the 15 patients (66.7%) with SCI treated with large-dose glucocorticoids after injury were diagnosed as having AI. In 12 patients with AI, the most frequent symptom was fatigue (66%), followed by orthostatic dizziness (50%), and anorexia (25%). In the chi-square test, the presence of AI was positively correlated with large-dose glucocorticoid use (p=0.008, Fisher exact test). CONCLUSION: Among the patients with SCI who manifested similar symptoms as those of AI, high incidence of AI was found especially in those who were treated with large-dose glucocorticoids. During management of SCI, if a patient has similar symptoms as those of AI, clinicians should consider the possibility of AI, especially when the patient has a history of large-dose glucocorticoid use. Early recognition and treatment of the underlying AI should be performed.
