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Clinical and Biochemical Parameters at Presentation of Patients with Adrenal Insufficiency Attending a Tertiary Care Hospital

Received: 30 October 2021     Accepted: 17 November 2021     Published: 24 December 2021
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Abstract

Background: Adrenal insufficiency is the clinical manifestation of deficient production or action of glucocorticoids, with or without deficiency of mineralocorticoids and adrenal androgens. It results from primary adrenal failure or secondary adrenal disease due to impairment of the hypothalamic–pituitary axis. Patients often have nonspecific symptoms such as weakness, fatigue, lethargy, anorexia, nausea, vomiting, fever, confusion or coma. Without appropriate therapy, shock progresses to coma and death. The aim of the study was to evaluate the clinical and biochemical parameters at presentation in patients admitted with adrenal insufficiency. Methods: Patients diagnosed with adrenal insufficiency fulfilling the diagnostic criteria were considered as study population. Purposive consecutive type of sampling method was applied. Data was collected in a structured questionnaire. All the data were analysed by SPSS V 22.0. Results: A total of 100 patients of adrenal insufficiency were included in the study. The most were in the age group of 51-60 years (33%), mean age ± SD was 50.82±13.51 years & 38% were male. In our study, 100% patients had generalized weakness, 88% had GI symptoms, 41% had vertigo and 18% had weight loss. Most of them (83%) had vomiting, 70% had nausea and only 17% had anorexia. 38% patients were anaemic and 23% had shock and 33% patients presented with adrenal crisis. In this study, 82% patient were hypotensive, 46% had postural hypotension. In our study, 56% had puffy face, 49% had history of weight gain, 26% had skin thinning. Mean Hb was 10.96 gm/dl, 25% had a serum creatinine of>1.2 mg/dl. Hypoglycaemia was present in 7%, 12% had high blood urea nitrogen, 71% had hyponatraemia, 39% had hyperkalaemia, 12% had hypercalcaemia and 20% had acidosis. Conclusion: Adrenal insufficiency presented with non-specific features like fatigue, weakness, vertigo, GI symptoms, unexplained fever or weight loss and specific pattern of biochemical findings like hyponatraemia, hyperkalaemia, mild acidosis, hypercalcaemia & hypoglycaemia. So, these features should raise the suspicion of adrenal insufficiency.

Published in International Journal of Diabetes and Endocrinology (Volume 6, Issue 4)
DOI 10.11648/j.ijde.20210604.16
Page(s) 160-166
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Clinical Parameters, Biochemical Parameters, Presentation, Adrenal Insufficiency

References
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    Rezwana Sobhan, Khan Mohammad Nazmus Saqeb, Mohammad Ibrahim, Aleya Ferdush Monni, Mohammad Faruque Pathan, et al. (2021). Clinical and Biochemical Parameters at Presentation of Patients with Adrenal Insufficiency Attending a Tertiary Care Hospital. International Journal of Diabetes and Endocrinology, 6(4), 160-166. https://doi.org/10.11648/j.ijde.20210604.16

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    ACS Style

    Rezwana Sobhan; Khan Mohammad Nazmus Saqeb; Mohammad Ibrahim; Aleya Ferdush Monni; Mohammad Faruque Pathan, et al. Clinical and Biochemical Parameters at Presentation of Patients with Adrenal Insufficiency Attending a Tertiary Care Hospital. Int. J. Diabetes Endocrinol. 2021, 6(4), 160-166. doi: 10.11648/j.ijde.20210604.16

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    AMA Style

    Rezwana Sobhan, Khan Mohammad Nazmus Saqeb, Mohammad Ibrahim, Aleya Ferdush Monni, Mohammad Faruque Pathan, et al. Clinical and Biochemical Parameters at Presentation of Patients with Adrenal Insufficiency Attending a Tertiary Care Hospital. Int J Diabetes Endocrinol. 2021;6(4):160-166. doi: 10.11648/j.ijde.20210604.16

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  • @article{10.11648/j.ijde.20210604.16,
      author = {Rezwana Sobhan and Khan Mohammad Nazmus Saqeb and Mohammad Ibrahim and Aleya Ferdush Monni and Mohammad Faruque Pathan and Mohammad Ashrafuzzaman},
      title = {Clinical and Biochemical Parameters at Presentation of Patients with Adrenal Insufficiency Attending a Tertiary Care Hospital},
      journal = {International Journal of Diabetes and Endocrinology},
      volume = {6},
      number = {4},
      pages = {160-166},
      doi = {10.11648/j.ijde.20210604.16},
      url = {https://doi.org/10.11648/j.ijde.20210604.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20210604.16},
      abstract = {Background: Adrenal insufficiency is the clinical manifestation of deficient production or action of glucocorticoids, with or without deficiency of mineralocorticoids and adrenal androgens. It results from primary adrenal failure or secondary adrenal disease due to impairment of the hypothalamic–pituitary axis. Patients often have nonspecific symptoms such as weakness, fatigue, lethargy, anorexia, nausea, vomiting, fever, confusion or coma. Without appropriate therapy, shock progresses to coma and death. The aim of the study was to evaluate the clinical and biochemical parameters at presentation in patients admitted with adrenal insufficiency. Methods: Patients diagnosed with adrenal insufficiency fulfilling the diagnostic criteria were considered as study population. Purposive consecutive type of sampling method was applied. Data was collected in a structured questionnaire. All the data were analysed by SPSS V 22.0. Results: A total of 100 patients of adrenal insufficiency were included in the study. The most were in the age group of 51-60 years (33%), mean age ± SD was 50.82±13.51 years & 38% were male. In our study, 100% patients had generalized weakness, 88% had GI symptoms, 41% had vertigo and 18% had weight loss. Most of them (83%) had vomiting, 70% had nausea and only 17% had anorexia. 38% patients were anaemic and 23% had shock and 33% patients presented with adrenal crisis. In this study, 82% patient were hypotensive, 46% had postural hypotension. In our study, 56% had puffy face, 49% had history of weight gain, 26% had skin thinning. Mean Hb was 10.96 gm/dl, 25% had a serum creatinine of>1.2 mg/dl. Hypoglycaemia was present in 7%, 12% had high blood urea nitrogen, 71% had hyponatraemia, 39% had hyperkalaemia, 12% had hypercalcaemia and 20% had acidosis. Conclusion: Adrenal insufficiency presented with non-specific features like fatigue, weakness, vertigo, GI symptoms, unexplained fever or weight loss and specific pattern of biochemical findings like hyponatraemia, hyperkalaemia, mild acidosis, hypercalcaemia & hypoglycaemia. So, these features should raise the suspicion of adrenal insufficiency.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Clinical and Biochemical Parameters at Presentation of Patients with Adrenal Insufficiency Attending a Tertiary Care Hospital
    AU  - Rezwana Sobhan
    AU  - Khan Mohammad Nazmus Saqeb
    AU  - Mohammad Ibrahim
    AU  - Aleya Ferdush Monni
    AU  - Mohammad Faruque Pathan
    AU  - Mohammad Ashrafuzzaman
    Y1  - 2021/12/24
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijde.20210604.16
    DO  - 10.11648/j.ijde.20210604.16
    T2  - International Journal of Diabetes and Endocrinology
    JF  - International Journal of Diabetes and Endocrinology
    JO  - International Journal of Diabetes and Endocrinology
    SP  - 160
    EP  - 166
    PB  - Science Publishing Group
    SN  - 2640-1371
    UR  - https://doi.org/10.11648/j.ijde.20210604.16
    AB  - Background: Adrenal insufficiency is the clinical manifestation of deficient production or action of glucocorticoids, with or without deficiency of mineralocorticoids and adrenal androgens. It results from primary adrenal failure or secondary adrenal disease due to impairment of the hypothalamic–pituitary axis. Patients often have nonspecific symptoms such as weakness, fatigue, lethargy, anorexia, nausea, vomiting, fever, confusion or coma. Without appropriate therapy, shock progresses to coma and death. The aim of the study was to evaluate the clinical and biochemical parameters at presentation in patients admitted with adrenal insufficiency. Methods: Patients diagnosed with adrenal insufficiency fulfilling the diagnostic criteria were considered as study population. Purposive consecutive type of sampling method was applied. Data was collected in a structured questionnaire. All the data were analysed by SPSS V 22.0. Results: A total of 100 patients of adrenal insufficiency were included in the study. The most were in the age group of 51-60 years (33%), mean age ± SD was 50.82±13.51 years & 38% were male. In our study, 100% patients had generalized weakness, 88% had GI symptoms, 41% had vertigo and 18% had weight loss. Most of them (83%) had vomiting, 70% had nausea and only 17% had anorexia. 38% patients were anaemic and 23% had shock and 33% patients presented with adrenal crisis. In this study, 82% patient were hypotensive, 46% had postural hypotension. In our study, 56% had puffy face, 49% had history of weight gain, 26% had skin thinning. Mean Hb was 10.96 gm/dl, 25% had a serum creatinine of>1.2 mg/dl. Hypoglycaemia was present in 7%, 12% had high blood urea nitrogen, 71% had hyponatraemia, 39% had hyperkalaemia, 12% had hypercalcaemia and 20% had acidosis. Conclusion: Adrenal insufficiency presented with non-specific features like fatigue, weakness, vertigo, GI symptoms, unexplained fever or weight loss and specific pattern of biochemical findings like hyponatraemia, hyperkalaemia, mild acidosis, hypercalcaemia & hypoglycaemia. So, these features should raise the suspicion of adrenal insufficiency.
    VL  - 6
    IS  - 4
    ER  - 

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Author Information
  • Department of Endocrinology and Metabolism, BIRDEM General Hospital, Dhaka, Bangladesh

  • Department of Gastrointestinal, Hepatobiliary & Pancreatic Diseases, Jahurul Islam Medical College & Hospital, Kishoreganj, Bangladesh

  • Department of Cardiology, Kuwait-Bangladesh Friendship Hospital, Dhaka, Bangladesh

  • Dhaka Medical College Hospital, Dhaka, Bangladesh

  • Department of Endocrinology and Metabolism, BIRDEM General Hospital, Dhaka, Bangladesh

  • Department of Endocrinology and Metabolism, BIRDEM General Hospital, Dhaka, Bangladesh

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