Acute Adrenal Insufficiency in Cervical Spinal Cord Injury

Pastrana, Emil A.; Saavedra, Fanor M.; Murray, Gisela; Estronza, Samuel; Rolston, John D.; Rodríguez–Vega, Gloria M.

doi:10.1016/j.wneu.2011.06.041

Cited by 16 publications

(13 citation statements)

References 20 publications

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“…Pastrana et al [8] reported that the incidence of AI in cervical SCI patients with neurogenic shock was 22%, which is much lower than that in our study. One explanation for this result is the difference in diagnostic criteria for AI.…”

Section: Discussioncontrasting

confidence: 84%

“…In our study, the cutoff for failure was defined as cortisol levels of less than 18 µg/dL sampled at 30 and 60 minutes after ACTH stimulation. However, in the study conducted by Pastrana et al [8], AI was defined as basal cortisol levels less than 15 µg/dL in the presence of neurogenic shock. Another explanation is that steroids for treatment of SCI were not administered as part of the spinal cord protection protocol in that study because of the long-term complications.…”

Section: Discussionmentioning

confidence: 99%

“…Pastrana et al [8] reported that the incidence of AI in cervical SCI patients with neurogenic shock was 22% and the average basal cortisol was 9.3 µg/dL in patients with AI versus 29.2 µg/dL in non-AI. However, to the best of our knowledge, a study assessing the incidence of AI in SCI patients with symptoms similar to those of AI is lacking.…”

Section: Introductionmentioning

confidence: 99%

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Large-Dose Glucocorticoid Induced Secondary Adrenal Insufficiency in Spinal Cord Injury

Park

Cho

2016

Ann Rehabil Med

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ObjectiveTo investigate the incidence of adrenal insufficiency (AI) in patients with spinal cord injury (SCI) with symptoms similar to those of AI and to assess the relevance of AI and large-dose glucocorticoids in SCI.MethodsThe medical records of 228 patients who were admitted to the rehabilitation center after SCI from January 2014 to January 2016 were reviewed retrospectively. Twenty-nine of 228 patients had persistent symptoms suspicious for AI despite continuous care for more than 4 weeks. Therefore, adrenocorticotropic hormone (ACTH) stimulation tests were conducted in these 29 patients.ResultsTwelve of these 29 patients (41.4%) with SCI who manifested AI-like symptoms were diagnosed as having AI. Among these 29 patients, 15 patients had a history of large-dose glucocorticoid treatment use and the other 14 patients did not have such a history. Ten of the 15 patients (66.7%) with SCI treated with large-dose glucocorticoids after injury were diagnosed as having AI. In 12 patients with AI, the most frequent symptom was fatigue (66%), followed by orthostatic dizziness (50%), and anorexia (25%). In the chi-square test, the presence of AI was positively correlated with large-dose glucocorticoid use (p=0.008, Fisher exact test).ConclusionAmong the patients with SCI who manifested similar symptoms as those of AI, high incidence of AI was found especially in those who were treated with large-dose glucocorticoids. During management of SCI, if a patient has similar symptoms as those of AI, clinicians should consider the possibility of AI, especially when the patient has a history of large-dose glucocorticoid use. Early recognition and treatment of the underlying AI should be performed.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Large-Dose Glucocorticoid Induced Secondary Adrenal Insufficiency in Spinal Cord Injury

Park

Cho

2016

Ann Rehabil Med

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“…That said, the consequences of missing the diagnosis can be life-threatening. Pastrana et al 19 reported that in 199 steroid-naïve persons with ASCI, AI was identified in 8 of 199 (4%) patients (e.g. 8 of 37 patients who met the criteria for neurogenic shock had AI), and the diagnosis of AI carried a higher risk of complications (P = 0.01), including intubation (P = 0.002), and a non-significant risk increase in 30-day mortality (13 vs. 3%, P = 0.39).…”

Section: Ai In Asci With and Without Glucocorticoid Administration: Imentioning

confidence: 99%

“…However, in the presence of neurogenic shock, AI is reported as high as 22%. 19 While the pathophysiology of AI in ASCI in a steroid-naïve patient is unclear, it is well known that administration of exogenous steroids in ASCI has the potential to suppress the hypothalamic pituitary axis (HPA) function. This can occur as soon as a few days after steroid administration and is typically dose-dependent.…”

Section: Ai In Asci With and Without Glucocorticoid Administration: Imentioning

confidence: 99%