To 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.
The 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.
Twelve 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).
Among 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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Adrenomyeloneuropathy (AMN), one of the variants of X-linked adrenoleukodystrophy (ALD), is inherited peroxisomal disorder associated with the accumulation of very long chain fatty acids (VLCFA). AMN is characterized primarily by involvements of long ascending and descending tracts of the spinal cord and peripheral neuropathy, which leads to spastic paraparesis and urinary and erectile dysfunction. We experienced the AMN case of a 33-year-old man presenting bilateral progressive spastic paraparesis, impotence and urge incontinence with primary adrenal failures, as confirmed by increased serum of VLCFA concentrations. Considering that somatosensory evoked potentials in posterior tibial nerve was the only abnormal finding in electrophysiologic findings when compared with the severe spastic gait pattern shown, it is necessary to follow up with electrophysiologic studies.
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