Ann Rehabil Med.  2016 Dec;40(6):1033-1039. 10.5535/arm.2016.40.6.1033.

Large-Dose Glucocorticoid Induced Secondary Adrenal Insufficiency in Spinal Cord Injury

• Park SH
• Cho KH

• KMID: 2371335
• DOI: http://doi.org/10.5535/arm.2016.40.6.1033

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.

Keyword

Spinal cord injuries; Adrenal insufficiency; Glucocorticoids

MeSH Terms

Adrenal Insufficiency*
Adrenocorticotropic Hormone
Anorexia
Dizziness
Fatigue
Glucocorticoids
Humans
Incidence
Medical Records
Rehabilitation Centers
Retrospective Studies
Spinal Cord Injuries*
Spinal Cord*
Adrenocorticotropic Hormone
Glucocorticoids

Figure

• 

  Fig. 1 Patient flow chart. ACTH, adrenocorticotropic hormone; AI, adrenal insufficiency.

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