Digestive symptoms in daily life of chronic adrenal insufficiency patients are similar to irritable bowel syndrome symptoms

L Quénéhervé,K Bach-Ngohou,D Drui,M Péré,E Coron,D Masson,G Barbara,J Blin,B Cariou,M Neunlist,M R Barbaro

doi:10.1038/s41598-021-87158-2

Abstract

Gastrointestinal symptoms are frequent in acute adrenal insufficiency. Although digestive symptoms can significantly reduce quality of life, they are rarely described in patients with treated chronic adrenal insufficiency (CAI). We aimed to characterize digestive symptoms in CAI patients. We used the section pertaining functional bowel disorders of the Rome IV questionnaire. A questionnaire was published on the website of the non-profit patient association “Adrenals” (NPPA of CAI patients) for five months. Information on demographics, characteristics of adrenal insufficiency, digestive symptoms and quality of life was collected. The relatives of CAI patients served as a control group. We analyzed responses of 33 control subjects and 119 patients (68 primary adrenal insufficiency (PAI), 30 secondary adrenal insufficiency (SAI) and 21 congenital adrenal hyperplasia (CAH)). Abdominal pain at least once a week over the past 3 months was reported by 40%, 47% and 33% of patients with PAI, SAI and CAH respectively versus 15% for the controls (p = 0.01). Symptoms were consistent with the Rome IV criteria for irritable bowel syndrome in 27%, 33% and 33% of patients respectively versus 6% for the controls (p < 0.0001). Quality of life was described as poor or very poor in 35%, 57% and 24% of patients respectively versus 5% for the controls (p < 0.0001). In conclusion, digestive symptoms are frequent and incapacitating in CAI patients and similar to symptoms of irritable bowel syndrome in 30% of CAI patients. Assessment and management of digestive symptoms should be considered a priority for physicians treating patients with CAI.

Highlights

Gastrointestinal symptoms are frequent in acute adrenal insufficiency
Reports of GI symptoms were comparable in different types of adrenal insufficiency. This exploratory study is the first to our knowledge to address the issue of digestive symptoms in chronic adrenal insufficiency (CAI) apart from adrenal crisis
As very few studies explore gastrointestinal symptoms in CAI11 and as disorders of the upper digestive tract are described more than the lower digestive tract, the results of our study shed new light on these sometimes disabling symptoms that patients do not spontaneously report to their specialist physician

Summary

Introduction

Digestive symptoms can significantly reduce quality of life, they are rarely described in patients with treated chronic adrenal insufficiency (CAI). Abdominal pain at least once a week over the past 3 months was reported by 40%, 47% and 33% of patients with PAI, SAI and CAH respectively versus 15% for the controls (p = 0.01). Digestive symptoms (abdominal pain, nausea, vomiting) have been described as some of the many nonspecific manifestations of acute and CAI prior to diagnosis, and sometimes lead to misdiagnosis of an acute abdomen. They are reported in cases of adrenal crisis, a life-threatening complication of CAI, resulting from acute glucocorticoid deficiency[2, 3]. 6 duplicates 25 patients under years 7 incomplete 6 unsatisfactory questionnaires from an gastroenterological point of view (missing data or suspicion/history of inflammatory bowel disease) unsatisfactory questionnaires from an endocrinological point of view (missing/irrelevant treatment data, absence of adrenal insufficiency ou unclear diagnosis)

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