Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Medical Hospitalist Unit, Asan Medical Center, Seoul, Korea.
J Korean Med Sci. 2022 Jul 18;37(28):e222. doi: 10.3346/jkms.2022.37.e222.
The symptoms of adrenal insufficiency (AI) overlap with the common effects of advanced cancer and chemotherapy. Considering that AI may negatively affect the overall prognosis of cancer patients if not diagnosed in a timely manner, we analyzed the incidence, risk factors, and predictive methods of AI in cancer patients.
We retrospectively analyzed the medical records of 184 adult patients with malignancy who underwent a rapid adrenocorticotrophic hormone stimulation test in the medical hospitalist units of a tertiary hospital. Their baseline characteristics and clinical features were evaluated, and the risk factors for AI were identified using logistic regression analysis.
Of the study patients, 65 (35%) were diagnosed with AI, in whom general weakness (63%) was the most common symptom. Multivariate logistic regression showed that eosinophilia (adjusted odds ratio [aOR], 4.28; 95% confidence interval [CI], 1.10-16.63; = 0.036), history of steroid use (aOR, 2.37; 95% CI, 1.10-5.15; = 0.028), and history of megestrol acetate use (aOR, 2.71; 95% CI, 1.38-5.33; = 0.004) were associated with AI. Baseline cortisol levels of 6.2 μg/dL and 12.85 μg/dL showed a specificity of 95.0% and 95.4% for AI diagnosis, respectively.
AI was found in about one-third of patients with cancer who showed general symptoms that may be easily masked by cancer or chemotherapy, suggesting that clinical suspicion of AI is important while treating cancer patients. History of corticosteroids or megestrol acetate were risk factors for AI and eosinophilia was a pre-test predictor of AI. Baseline cortisol level appears to be a useful adjunct marker for AI.
肾上腺功能不全 (AI) 的症状与晚期癌症和化疗的常见影响相重叠。考虑到 AI 如果不能及时诊断，可能会对癌症患者的整体预后产生负面影响，因此我们分析了癌症患者 AI 的发生率、危险因素和预测方法。
我们回顾性分析了在一家三级医院的医疗住院医师单位接受快速促肾上腺皮质激素刺激试验的 184 名成年恶性肿瘤患者的病历。评估了他们的基线特征和临床特征，并使用逻辑回归分析确定了 AI 的危险因素。
在研究患者中，有 65 例 (35%) 被诊断为 AI，其中全身乏力 (63%) 是最常见的症状。多变量逻辑回归显示嗜酸性粒细胞增多症 (调整后的优势比 [aOR]，4.28；95%置信区间 [CI]，1.10-16.63； = 0.036)、类固醇使用史 (aOR，2.37；95% CI，1.10-5.15； = 0.028) 和甲泼尼龙醋酸酯使用史 (aOR，2.71；95% CI，1.38-5.33； = 0.004) 与 AI 相关。基线皮质醇水平为 6.2μg/dL 和 12.85μg/dL 时，对 AI 诊断的特异性分别为 95.0%和 95.4%。
在表现出可能被癌症或化疗掩盖的全身症状的癌症患者中，约有三分之一发现 AI，这表明在治疗癌症患者时，临床怀疑 AI 很重要。皮质激素或甲泼尼龙醋酸酯的使用史是 AI 的危险因素，嗜酸性粒细胞增多症是 AI 的预测指标。基线皮质醇水平似乎是 AI 的有用辅助标志物。
