Delay in Diagnosis of Adrenal Insufficiency Is a Frequent Cause of Adrenal Crisis

Lucyna Papierska,Michał Rabijewski

doi:10.1155/2013/482370

Abstract

Delay of diagnosis of primary adrenal insufficiency (PAI) leads to adrenal crisis which is potentially lethal complication. The objective of our work was an assessment whether the establishment of diagnosis of adrenocortical insufficiency in Poland is so much delayed as assessed in the past. We have analysed data from 60 patients with diagnosis of PAI established in our department during the past 12 years and who are still under our care. We found that the time to diagnosis of primary adrenal insufficiency in Poland exceeds 3 months in every patient and 6 months in patients admitted with symptoms of adrenal crisis. Forty-four percent of patients were diagnosed only just after the hospitalisation due to crisis, despite the evident signs and symptoms of PAI. Lack of appetite and loss of body weight occurred in all patients and for that reason a diagnosis of chronic gastric and duodenal ulcer disease was the most often incorrect diagnosis. After the proper diagnosis and treatment, in the course of 1–11 years of observation, there was only 6 imminent adrenal crises in 5 patients. Our results indicated that training of primary care physicians in the field of recognising and treatment of adrenal insufficiency is still essential.

Highlights

The primary adrenocortical insufficiency, that is, Addison’s disease, has already been identified and described in the mid-19th century [1]
All the diagnoses were confirmed by a low blood concentration of cortisol in the morning (89.6 nmol/L ± 22.4; normal range 140–799 nmol/L), a high concentration of ACTH (184.8 pmol/L ± 78.3; normal range: 2.2−11 pmol/L)
In the analysed group of patients, the diagnosis of adrenocortical insufficiency was for the first time established during the adrenal crisis in 13 patients (22%) and in other 13 (22%) patients just as symptoms of imminent adrenal crisis appeared

Summary

Introduction

The primary adrenocortical insufficiency, that is, Addison’s disease, has already been identified and described in the mid-19th century [1]. On the grounds of the foregoing data one can presume that primary adrenocortical insufficiency affects at least 4000 persons in Poland, and we can expect to encounter about 200 new diagnoses of this disease yearly [4]. According to Zelissen, its most dangerous complication, that is, adrenal crisis, occurs before Addison’s disease is diagnosed in half of the patients. Bleicken et al stated that 50% of affected individuals report evident symptoms of adrenocortical insufficiency at least half a year prior to establishment of the diagnosis, and every fifth patient waits for a correct diagnosis for more than 5 years [6]. In Norwegian study every third patient was diagnosed very quickly—already after one month of the symptoms, but 40% of affected persons waited for diagnosis more than 6 months [7].

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