Endocrinology and Diabetes Unit, Department of Medicine I, University of Würzburg, Oberdürrbacher Str. 6, D-97080 Würzburg, Germany.
Eur J Endocrinol. 2010 Mar;162(3):597-602. doi: 10.1530/EJE-09-0884. Epub 2009 Dec 2.
Adrenal crisis (AC) is a life-threatening complication of adrenal insufficiency (AI). Here, we evaluated frequency, causes and risk factors of AC in patients with chronic AI.
In a cross-sectional study, 883 patients with AI were contacted by mail. Five-hundred and twenty-six patients agreed to participate and received a disease-specific questionnaire.
Four-hundred and forty-four datasets were available for analysis (primary AI (PAI), n=254; secondary AI (SAI), n=190). Forty-two percent (PAI 47% and SAI 35%) reported at least one crisis. Three hundred and eighty-four AC in 6092 patient years were documented (frequency of 6.3 crises/100 patient years). Precipitating causes were mainly gastrointestinal infection and fever (45%) but also other stressful events (e.g. major pain, surgery, psychic distress, heat and pregnancy). Sudden onset of apparently unexplained AC was also reported (PAI 6.6% and SAI 12.7%). Patients with PAI reported more frequent emergency glucocorticoid administration (42.5 vs 28.4%, P=0.003). Crisis incidence was not influenced by educational status, body mass index, glucocorticoid dose, DHEA treatment, age at diagnosis, hypogonadism, hypothyroidism or GH deficiency. In PAI, patients with concomitant non-endocrine disease were at higher risk of crisis (odds ratio (OR)=2.02, 95% confidence interval (CI) 1.05-3.89, P=0.036). In SAI, female sex (OR=2.18, 95% CI 1.06-4.5, P=0.035) and diabetes insipidus (OR=2.71, 95% CI 1.22-5.99, P=0.014) were associated with higher crisis incidence.
AC occurs in a substantial proportion of patients with chronic AI, mainly triggered by infectious disease. Only a limited number of risk factors suitable for targeting prevention of AC were identified. These findings indicate the need for new concepts of crisis prevention in patients with AI.
肾上腺危象（AC）是肾上腺功能不全（AI）的一种危及生命的并发症。在这里，我们评估了慢性 AI 患者中 AC 的频率、原因和危险因素。
在一项横断面研究中，通过邮件联系了 883 名 AI 患者。526 名患者同意参与并收到了一份疾病特异性问卷。
有 444 个数据集可供分析（原发性 AI（PAI），n=254；继发性 AI（SAI），n=190）。报告了至少一次危象的患者占 42%（PAI 为 47%，SAI 为 35%）。在 6092 个患者年中记录了 384 例 AC（频率为 6.3 例/100 患者年）。诱发原因主要是胃肠道感染和发热（45%），但也有其他应激事件（如严重疼痛、手术、精神压力、高温和妊娠）。也有报告称突然出现明显原因不明的 AC（PAI 为 6.6%，SAI 为 12.7%）。报告需要紧急给予糖皮质激素的 PAI 患者更多（42.5%比 28.4%，P=0.003）。危象发生率不受教育程度、体重指数、糖皮质激素剂量、DHEA 治疗、诊断时年龄、性腺功能减退症、甲状腺功能减退症或 GH 缺乏症的影响。在 PAI 中，伴有非内分泌疾病的患者发生危象的风险更高（比值比（OR）=2.02，95%置信区间（CI）1.05-3.89，P=0.036）。在 SAI 中，女性（OR=2.18，95%CI 1.06-4.5，P=0.035）和尿崩症（OR=2.71，95%CI 1.22-5.99，P=0.014）与更高的危象发生率相关。
AC 发生在相当一部分慢性 AI 患者中，主要由感染性疾病引起。仅确定了少数适合预防 AC 的危险因素。这些发现表明需要为 AI 患者制定新的预防危象概念。
