Hosseinzadeh Ali, Hou Rangchun, Zeng Roy Rongyue, Calderón-Juárez Martín, Lau Benson Wui Man, Fong Kenneth Nai Kuen, Wong Arnold Yu Lok, Zhang Jack Jiaqi, Sánchez Vidaña Dalinda Isabel, Miller Tiev, Kwong Patrick Wai Hang
Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
J Clin Med. 2025 Mar 21;14(7):2141. doi: 10.3390/jcm14072141.
: Spinal cord injury (SCI) causes profound autonomic and endocrine dysfunctions, giving rise to adrenal insufficiency (AI), which is marked by a reduction in steroid hormone production. Left unaddressed, SCI-related AI (SCI-AI) can lead to life-threatening consequences such as severe hypotension and shock (i.e., adrenal crisis). However, symptoms are often non-specific, making AI challenging to distinguish from similar or overlapping cardiovascular conditions (e.g., orthostatic hypotension). Additionally, the etiology of SCI-AI remains unknown. This review aimed to synthesize the current literature reporting the prevalence, symptomology, and management of SCI-AI. A systematic search was performed to identify studies reporting AI following the cessation of glucocorticoid treatments in individuals with traumatic SCI. A random-effects meta-analysis was conducted to investigate the overall prevalence of SCI-AI. Thirteen studies involving 545 individuals with traumatic SCI, most with cervical level injuries (n = 256), met the review criteria. A total of 4 studies were included in the meta-analysis. Primary analysis results indicated an SCI-AI pooled prevalence of 24.3% (event rate [ER] = 0.243, 95% confidence interval [CI] = 0.073-0.565, n = 4). Additional sensitivity analyses showed a pooled prevalence of 46.3% (ER = 0.463, 95%CI = 0.348-0.582, n = 2) and 10.8% (ER = 0.108, 95%CI = 0.025-0.368, n = 2) for case-control and retrospective cohort studies, respectively. High-dose glucocorticoid administration after SCI as well as the injury itself appear to contribute to the development of AI. The estimated prevalence of AI in people with traumatic SCI was high (24%). Prevalence was also greater among individuals with cervical SCI than those with lower-level lesions. Clinicians should be vigilant in recognizing the symptomatology and onset of SCI-AI. Further research elucidating its underlying pathophysiology is needed to optimize glucocorticoid administration for remediating AI in this vulnerable population.
脊髓损伤（SCI）会导致严重的自主神经和内分泌功能障碍，引发肾上腺功能不全（AI），其特征是类固醇激素分泌减少。若不加以处理，与SCI相关的AI（SCI-AI）可能会导致危及生命的后果，如严重低血压和休克（即肾上腺危象）。然而，症状往往不具有特异性，使得AI难以与类似或重叠的心血管疾病（如直立性低血压）区分开来。此外，SCI-AI的病因仍然不明。本综述旨在综合当前报道SCI-AI的患病率、症状和管理的文献。进行了系统检索，以识别报告创伤性SCI患者停用糖皮质激素治疗后出现AI的研究。进行随机效应荟萃分析以调查SCI-AI的总体患病率。13项涉及545例创伤性SCI患者的研究符合综述标准，其中大多数为颈椎损伤（n = 256）。荟萃分析共纳入4项研究。初步分析结果表明，SCI-AI的合并患病率为24.3%（事件发生率[ER] = 0.243，95%置信区间[CI] = 0.073 - 0.565，n = 4）。额外的敏感性分析显示，病例对照研究和回顾性队列研究的合并患病率分别为46.3%（ER = 0.463，95%CI = 0.348 - 0.582，n = 2）和10.8%（ER = 0.108，95%CI = 0.025 - 0.368，n = 2）。SCI后大剂量糖皮质激素给药以及损伤本身似乎都有助于AI的发生。创伤性SCI患者中AI的估计患病率较高（24%）。颈椎SCI患者的患病率也高于较低节段损伤的患者。临床医生应警惕识别SCI-AI的症状和发病情况。需要进一步研究阐明其潜在的病理生理学，以优化糖皮质激素给药，从而在这一脆弱人群中纠正AI。
