Einarsdottir Margret J, Trimpou Penelope, Johannsson Gudmundur, Ragnarsson Oskar
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Endocr Connect. 2024 Mar 20;13(4). doi: 10.1530/EC-23-0535. Print 2024 Apr 1.
It is unknown whether glucocorticoid (GC)-induced adrenal insufficiency may cause premature mortality in GC users. We conducted a retrospective cohort study to investigate if undiagnosed and undertreated GC-induced adrenal insufficiency is a contributor to premature death in GC users.
Information on dispensed prescriptions in West Sweden from 2007 to 2014 was obtained from the Swedish Prescribed Drug Register. Cause of death was collected from the Swedish Cause of Death Register. Of 223,211 patients who received oral GC prescriptions, 665 died from sepsis within 6 months of their last prescription. Three hundred of these patients who had died in hospital were randomly selected for further investigation. Medical records were initially reviewed by one investigator. Furthermore, two additional investigators reviewed the medical records of patients whose deaths were suspected to be caused by GC-induced adrenal insufficiency.
Of 300 patients (121 females, 40%), 212 (75%) were prescribed GC treatment at admission. The mean age was 76 ± 11 years (range 30-99). Undiagnosed or undertreated GC-induced adrenal insufficiency was considered a probable contributor to death by at least two investigators in 11 (3.7%) patients. In five of these 11 cases, long-term GC therapy was abruptly discontinued during hospitalization. Undiagnosed or undertreated GC-induced adrenal insufficiency was considered a possible contributing factor to death in a further 36 (12%) patients.
GC-induced adrenal insufficiency is an important contributor to premature death in GC users. Awareness of the disorder during intercurrent illness and following cessation of GC treatment is essential.
糖皮质激素（GC）诱发的肾上腺功能不全是否会导致GC使用者过早死亡尚不清楚。我们进行了一项回顾性队列研究，以调查未诊断和治疗不足的GC诱发的肾上腺功能不全是否是GC使用者过早死亡的一个因素。
从瑞典处方药登记处获取2007年至2014年瑞典西部已配发处方的信息。死亡原因从瑞典死亡原因登记处收集。在223211名接受口服GC处方的患者中，665人在最后一次处方后的6个月内死于败血症。随机选择其中300名在医院死亡的患者进行进一步调查。医疗记录最初由一名研究人员进行审查。此外，另外两名研究人员审查了疑似因GC诱发的肾上腺功能不全导致死亡的患者的医疗记录。
在300名患者（121名女性，40%）中，212名（75%）在入院时接受了GC治疗。平均年龄为76±11岁（范围30 - 99岁）。至少两名研究人员认为，11名（3.7%）患者的死亡可能是由未诊断或治疗不足的GC诱发的肾上腺功能不全所致。在这11例病例中的5例中，长期GC治疗在住院期间突然中断。另外36名（12%）患者的死亡可能是由未诊断或治疗不足的GC诱发的肾上腺功能不全所致。
GC诱发的肾上腺功能不全是GC使用者过早死亡的一个重要因素。在并发疾病期间和GC治疗停止后，对该疾病的认识至关重要。
