Clinical characteristics of acute adrenal insufficiency in emergency patients: an analysis of data in Lhasa, Xizang Autonomous Region of China

doi:10.5847/wjem.j.1920-8642.2025.085

Abstract

Abstract:

BACKGROUND: The nonspecific clinical presentation of adrenal insufficiency (AI) frequently leads to misdiagnosis, often as psychiatric or gastrointestinal disorders. AI is classified anatomically as primary AI (PAI), secondary AI (SAI), or tertiary AI (TAI). Without timely recognition, progression to adrenal crisis (AC) can result in life-threatening outcomes. This study aimed to systematically analyze the clinical features, etiologies, and outcomes of AI in Lhasa’s emergency population to improve diagnostic accuracy and optimize clinical management.

METHODS: A retrospective analysis of emergency department admissions from January 2020 to August 2024 at People’s Hospital of Xizang Autonomous Region was conducted. AI diagnoses were identified via International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes from electronic health records (EHR). Patients were grouped into incipient AC (IAC) or AC cohorts based on hemodynamic status. Demographic profiles, etiologies, clinical presentations, and laboratory results were analyzed.

RESULTS: Forty-three AI patients were identified. The population-standardized admission rate for AI increased from 9 to 16 per million person-years, with PAI cases doubling during this period. Adrenal tuberculosis (58.1%) and adrenal hematoma (18.6%) were the leading etiologies. Compared to the IAC group, the AC group demonstrated lower systolic blood pressure (SBP) (P=0.001) and diastolic blood pressure (DBP) (P<0.001); higher neutrophil count (P=0.048), eosinophil count (P=0.044), CRP (P=0.004), blood urea nitrogen (BUN) (P=0.007); lower sodium (P<0.001) and glucose levels (P=0.001). The hospital stay was longer in the AC group (20 d vs. 14 d; P<0.001).

CONCLUSION: AI incidence is rising in high-altitude regions, with adrenal tuberculosis remaining the most common cause. AC is associated with increased inflammatory responses, hemodynamic instability, and metabolic disturbances. Targeted interventions are required to improve outcomes.

Key words: Adrenal insufficiency, Adrenal crisis, Emergency

Guiying Dong, Jianbo Yu, Lobsang Chodron, Tenzin Chodron, Peiliang Gao, Xueying Fu, Jihong Zhu, Zhenzhong Yang, Lobsang Cering. Clinical characteristics of acute adrenal insufficiency in emergency patients: an analysis of data in Lhasa, Xizang Autonomous Region of China[J]. World Journal of Emergency Medicine, 2025, 16(5): 481-485.

Figures/Tables 3

Figure 1.

Figure 2.

Table 1.

Demographic and clinical information of adrenal insufficiency patients

Parameters	All (n=43)	Adrenal crisis (n=16)	Incipient adrenal crisis (n=27)	P-value
Demographics
Male, n (%)	23 (53.5)	9 (56.3)	14 (51.9)	0.780
Age, median (IQR), years	49 (38, 55)	52 (42, 54)	50 (43, 54)	0.086
Body mass index, median (IQR), kg/m²	20 (20, 23)	18 (17, 21)	22 (20, 24)	0.140
Symptoms, n (%)
Fatigue	22 (51.2)	7 (43.8)	15 (55.6)	0.454
Abdominal pain and diarrhea	17 (39.5)	6 (37.5)	11 (40.7)	0.834
Anorexia	18 (41.9)	8 (50.0)	10 (37.0)	0.405
Nausea and vomiting	20 (46.5)	10 (62.5)	10 (37.0)	0.106
Fever	2 (4.7)	1 (6.3)	1 (3.7)	0.702
Confusion	4 (9.3)	1 (6.3)	3 (11.1)	0.596
Signs
Hyperpigmentation, n (%)	14 (32.6)	5 (31.3)	9 (33.3)	0.888
Temperature, median (IQR), ℃	36.4 (36.2, 36.6)	36.4 (36.3, 36.5)	36.2 (36.2, 36.3)	0.893
Heart rate, median (IQR), beats/min	80 (70, 92)	93 (80, 101)	95 (86, 98)	0.275
Systolic blood pressure, median (IQR), mmHg	96 (89, 112)	90 (88, 91)	103 (95, 111)	<0.001*
Diastolic blood pressure, median (IQR), mmHg	61 (54, 77)	46 (45, 60)	57 (54, 73)	<0.001*
Endocrine results
Adrenocorticotropic hormone, median (IQR), pg/mL	251 (36, 888)	838 (565, 1136)	579 (14, 1146)	0.533
Cortisol, median (IQR), μg/dL	3.17 (1.66, 5.63)	1.86 (0.86, 4.35)	3.41 (1.80, 5.18)	0.899
Free triiodothyronine (FT3), median (IQR), pg/mL	3.0 (2.2, 3.6)	3.6 (2.6, 6.7)	3.8 (3.1, 4.1)	0.069
Free thyroxine (FT4), median (IQR), ng/dL	1.08 (0.84, 1.39)	0.99 (0.87, 1.08)	1.56 (1.32, 1.62)	0.199
Blood routine results
White blood count, median (IQR), ×10⁹/L	5.5 (4.0, 8.7)	5.6 (4.4, 7.5)	5.4 (4.0, 6.3)	0.077
Neutrophil count, median (IQR), ×10⁹/L	2.8 (1.8, 5.3)	2.8 (2.4, 3.6)	2.1 (1.4, 3.3)	0.048*
Lymphocyte count, median (IQR), ×10⁹/L	1.5 (1.0, 2.0)	2.23 (1.44, 3.21)	2.15 (1.80, 2.92)	0.978
Eosinophil count, median (IQR), ×10⁹/L	0.10 (0.02, 0.15)	0.19 (0.11, 0.26)	0.13 (0.07, 0.16)	0.044*
Hemoglobin, median (IQR), g/L	133 (112, 157)	133 (104, 164)	165 (124, 180)	0.042*
Platelet count, median (IQR), ×10⁹/L	213 (175, 261)	225 (179, 286)	213 (142, 311)	0.286
Biochemical results
Sodium, median (IQR), mmol/L	132 (125, 140)	115 (107, 119)	132 (128, 134)	<0.001*
Potassium, median (IQR), mmol/L	4.2 (3.8, 4.7)	5.3 (3.5, 5.5)	5.0 (4.6, 5.8)	0.472
Blood urea nitrogen, median (IQR), mmol/L	5.85 (3.51, 7.60)	7.13 (4.05, 11.81)	4.63 (3.23, 6.55)	0.007*
Serum creatinine, median (IQR), μmol/L	68 (54, 90)	83 (63, 91)	76 (65, 95)	0.095
Glucose, median (IQR), mmol/L	5.0 (4.1, 6.0)	4.1 (3.8, 5.2)	5.1 (4.1, 6.0)	0.001*
Clinical outcomes
Hospitalization duration, median (IQR), d	13 (9, 18)	20 (19, 21)	14 (11, 17)	<0.001*

Table 1.

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