Department of General MedicineNational Defense Medical College, Tokorozawa, Saitama, Japan.
Department of Clinical Epidemiology and Health EconomicsSchool of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Eur J Endocrinol. 2017 Mar;176(3):329-337. doi: 10.1530/EJE-16-0803.
Adrenal crisis is an endocrine emergency that requires prompt diagnosis and treatment. However, the clinical features and practice patterns of treatment for adrenal crisis are not completely understood.
To investigate patient characteristics, comorbidities and treatments of adrenal crisis.
We conducted a cross-sectional study of patients who received intravenous glucocorticoids for adrenal crisis at admission from 1 July 2007 to 31 March 2014, using a national inpatient database in Japan.
Among approximately 34 million inpatients in the database, we identified 799 patients diagnosed with adrenal crisis and coexisting primary or secondary adrenal insufficiency at admission. The median (interquartile range) age was 58 (28-73) years, and the overall in-hospital mortality was 2.4% (19 of 799 patients). The most common comorbidity at admission was infections excluding pneumonia and gastroenteritis (15.0%). There were 68 (8.5%) patients with gastroenteritis, and no deaths occurred among these patients. The patients with secondary adrenal insufficiency showed significantly higher proportions of admission to ICU, extracellular fluid resuscitation, insulin therapy and catecholamine use than the patients with primary adrenal insufficiency. There were no significant between-group differences in mortality rate and variation in intravenous glucocorticoids (short-acting glucocorticoid, hydrocortisone; moderate-acting glucocorticoid, prednisolone or methylprednisolone; long-acting glucocorticoid, dexamethasone or betamethasone). Of the 19 dead patients, 15 were aged above 60 years, 12 had impaired consciousness at admission and 13 received insulin therapy.
Clinicians should be aware that older patients with impaired consciousness and diabetes mellitus are at relatively high risk of death from adrenal crisis.
肾上腺危象是一种内分泌急症，需要及时诊断和治疗。然而，对于肾上腺危象的临床特征和治疗方案，我们还没有完全了解。
研究肾上腺危象患者的特征、合并症和治疗方法。
我们对 2007 年 7 月 1 日至 2014 年 3 月 31 日期间在日本全国住院患者数据库中因肾上腺危象而接受静脉用糖皮质激素治疗的患者进行了一项横断面研究。
在该数据库中，约 3400 万住院患者中，我们确定了 799 例入院时诊断为肾上腺危象且并存原发性或继发性肾上腺功能不全的患者。患者的中位（四分位间距）年龄为 58（28-73）岁，总体住院死亡率为 2.4%（799 例患者中有 19 例）。入院时最常见的合并症是感染（不包括肺炎和胃肠炎）（15.0%）。有 68 例（8.5%）患者患有胃肠炎，这些患者中没有死亡病例。与原发性肾上腺功能不全患者相比，继发性肾上腺功能不全患者更有可能入住 ICU、接受细胞外液复苏、接受胰岛素治疗和使用儿茶酚胺。两组患者的死亡率和静脉用糖皮质激素（短效糖皮质激素，氢化可的松；中效糖皮质激素，泼尼松或甲泼尼龙；长效糖皮质激素，地塞米松或倍他米松）的使用情况均无显著差异。在 19 例死亡患者中，15 例年龄超过 60 岁，12 例入院时意识障碍，13 例接受胰岛素治疗。
临床医生应注意，年龄较大、意识障碍和患有糖尿病的患者发生肾上腺危象死亡的风险相对较高。
