Adrenal insufficiency natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayeesha Kattubadi, M.B.B.S[2]
Overview
Common complications of adrenal insufficiency include cardiovascular complications, disturbed sleep, reduced bone mineral density. Prognosis is generally excellent with replacement therapy.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of adrenal insufficiency usually develop in the third to fifth decade of life, and start with symptoms such as fatigue, anorexia, weight loss, nausea, abdominal pain.
- If left untreated, chronic adrenal insufficiency in the presence of precipitating factors can develop adrenal crisis presenting with acute hemodynamic compromise. [1]
Complications
- Common complications of adrenal insufficiency include: [2]
- Increased risk of cardiovascular complications.
- Sleep disturbance due to disruption of circadian rhythm.
- Decreased bone mineral density as a consequence of glucocorticoid therapy.
- Fertility and pregnancy complications: Reduced fertility, increased risk of fetal growth restriction, preterm birth, cesarean delivery
Prognosis
- Prognosis is generally excellent with replacement therapy.
- Depending on the age of the diagnosis of adrenal insufficiency the prognosis may vary. If the patient is diagnosed before the age of 40, there is increased mortality.
- Mortality is increased in patients presenting with acute adrenal crisis, infection, or associated with type 1 diabetes mellitus [3]
References
- ↑ Pazderska, Agnieszka; Pearce, Simon HS (2017). "Adrenal insufficiency – recognition and management". Clinical Medicine. 17 (3): 258–262. doi:10.7861/clinmedicine.17-3-258. ISSN 1470-2118.
- ↑ "www.amjmed.com".
- ↑ Erichsen, Martina M; Løvås, Kristian; Fougner, Kristian J; Svartberg, Johan; Hauge, Erik R; Bollerslev, Jens; Berg, Jens P; Mella, Bjarne; Husebye, Eystein S (2009). "Normal overall mortality rate in Addison's disease, but young patients are at risk of premature death". European Journal of Endocrinology. 160 (2): 233–237. doi:10.1530/EJE-08-0550. ISSN 0804-4643.