Adrenal insufficiency natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayeesha Kattubadi, M.B.B.S[2] Muhammad Saad, M.B.B.S.[3]
Overview
Common complications of adrenal insufficiency include cardiovascular complications, disturbed sleep, reduced bone mineral density. Prognosis is generally excellent with replacement therapy.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of adrenal insufficiency usually develop in the third to fifth decade of life, and start with symptoms such as fatigue, anorexia, weight loss, nausea, abdominal pain.
- If left untreated, chronic adrenal insufficiency in the presence of precipitating factors can develop adrenal crisis presenting with acute hemodynamic compromise. [1]
- Up to half of patients with primary adrenal insufficiency may experience adrenal crisis prior to diagnosis. [2]
Complications
- Common complications of adrenal insufficiency include: [3]
- Increased risk of cardiovascular complications.
- Sleep disturbance due to disruption of circadian rhythm.
- Decreased bone mineral density as a consequence of glucocorticoid therapy.
- Fertility and pregnancy complications: Reduced fertility, increased risk of fetal growth restriction, preterm birth, cesarean delivery
Prognosis
- Prognosis is generally excellent with replacement therapy and patients are able to work, travel and participate in sports[4] [5].
- Depending on the age of the diagnosis of adrenal insufficiency the prognosis may vary. If the patient is diagnosed before the age of 40, there is increased mortality.
- Mortality is increased in patients presenting with acute adrenal crisis, infection, or associated with type 1 diabetes mellitus [6].
- Patients with glucocorticoid-induced adrenal insufficiency may recover hypothalamic-pituitary-adrenal axis function over months to years after discontinuation of glucocorticoids [2].
References
- ↑ Pazderska, Agnieszka; Pearce, Simon HS (2017). "Adrenal insufficiency – recognition and management". Clinical Medicine. 17 (3): 258–262. doi:10.7861/clinmedicine.17-3-258. ISSN 1470-2118.
- ↑ 2.0 2.1 "Adrenal Insufficiency in Adults: A Review | Endocrinology | JAMA | JAMA Network".
- ↑ "www.amjmed.com".
- ↑ Li D, Brand S, Hamidi O, Westfall AA, Suresh M, Else T, Vaidya A, Bancos I (June 2022). "Quality of Life and its Determinants in Patients With Adrenal Insufficiency: A Survey Study at 3 Centers in the United States". J Clin Endocrinol Metab. 107 (7): e2851–e2861. doi:10.1210/clinem/dgac175. PMC 9202727 Check
|pmc=value (help). PMID 35350067 Check|pmid=value (help). - ↑ Li D, Genere N, Behnken E, Xhikola M, Abbondanza T, Vaidya A, Bancos I (March 2021). "Determinants of Self-reported Health Outcomes in Adrenal Insufficiency: A Multisite Survey Study". J Clin Endocrinol Metab. 106 (3): e1408–e1419. doi:10.1210/clinem/dgaa668. PMC 7947833 Check
|pmc=value (help). PMID 32995875 Check|pmid=value (help). - ↑ Erichsen, Martina M; Løvås, Kristian; Fougner, Kristian J; Svartberg, Johan; Hauge, Erik R; Bollerslev, Jens; Berg, Jens P; Mella, Bjarne; Husebye, Eystein S (2009). "Normal overall mortality rate in Addison's disease, but young patients are at risk of premature death". European Journal of Endocrinology. 160 (2): 233–237. doi:10.1530/EJE-08-0550. ISSN 0804-4643.