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The Prevalence of Adrenal Insufficiency in Individuals with Traumatic Spinal Cord Injury : A Systematic Review and Meta-Analysis Hosseinzadeh, Ali; Hou, Rangchun; Zeng, Roy Rongyue; Calderón-Juárez, Martín; Lau, Benson Wui Man; Fong, Kenneth Nai Kuen; Wong, Arnold Yu Lok; Zhang, Jack Jiaqi; Sánchez Vidaña, Dalinda Isabel; Miller, Tiev; Kwong, Patrick Wai Hang
Abstract
Background/Objectives: Spinal cord injury (SCI) causes profound autonomic and endocrine dysfunctions, giving rise to adrenal insufficiency (AI), which is marked by a reduction in steroid hormone production. Left unaddressed, SCI-related AI (SCIAI) can lead to life-threatening consequences such as severe hypotension and shock (i.e., adrenal crisis). However, symptoms are often non-specific, making AI challenging to distinguish from similar or overlapping cardiovascular conditions (e.g., orthostatic hypotension). Additionally, the etiology of SCI-AI remains unknown. This review aimed to synthesize the current literature reporting the prevalence, symptomology, and management of SCI-AI. Methods: A systematic search was performed to identify studies reporting AI following the cessation of glucocorticoid treatments in individuals with traumatic SCI. A random-effects meta-analysis was conducted to investigate the overall prevalence of SCI-AI. Results: Thirteen studies involving 545 individuals with traumatic SCI, most with cervical level injuries (n = 256), met the review criteria. A total of 4 studies were included in the meta-analysis. Primary analysis results indicated an SCI-AI pooled prevalence of 24.3% (event rate [ER] = 0.243, 95% confidence interval [CI] = 0.073–0.565, n = 4). Additional sensitivity analyses showed a pooled prevalence of 46.3% (ER = 0.463, 95%CI = 0.348–0.582, n = 2) and 10.8% (ER = 0.108, 95%CI = 0.025–0.368, n = 2) for case–control and retrospective cohort studies, respectively. High-dose glucocorticoid administration after SCI as well as the injury itself appear to contribute to the development of AI. Conclusions: The estimated prevalence of AI in people with traumatic SCI was high (24%). Prevalence was also greater among individuals with cervical SCI than those with lower-level lesions. Clinicians should be vigilant in recognizing the symptomatology and onset of SCI-AI. Further research elucidating its underlying pathophysiology is needed to optimize glucocorticoid administration for remediating AI in this vulnerable population.
Item Metadata
| Title |
The Prevalence of Adrenal Insufficiency in Individuals with Traumatic Spinal Cord Injury : A Systematic Review and Meta-Analysis
|
| Creator | |
| Publisher |
Multidisciplinary Digital Publishing Institute
|
| Date Issued |
2025-03-21
|
| Description |
Background/Objectives: Spinal cord injury (SCI) causes profound autonomic
and endocrine dysfunctions, giving rise to adrenal insufficiency (AI), which is marked
by a reduction in steroid hormone production. Left unaddressed, SCI-related AI (SCIAI)
can lead to life-threatening consequences such as severe hypotension and shock (i.e.,
adrenal crisis). However, symptoms are often non-specific, making AI challenging to
distinguish from similar or overlapping cardiovascular conditions (e.g., orthostatic hypotension).
Additionally, the etiology of SCI-AI remains unknown. This review aimed to
synthesize the current literature reporting the prevalence, symptomology, and management
of SCI-AI. Methods: A systematic search was performed to identify studies reporting AI
following the cessation of glucocorticoid treatments in individuals with traumatic SCI.
A random-effects meta-analysis was conducted to investigate the overall prevalence of
SCI-AI. Results: Thirteen studies involving 545 individuals with traumatic SCI, most with
cervical level injuries (n = 256), met the review criteria. A total of 4 studies were included in
the meta-analysis. Primary analysis results indicated an SCI-AI pooled prevalence of 24.3%
(event rate [ER] = 0.243, 95% confidence interval [CI] = 0.073–0.565, n = 4). Additional
sensitivity analyses showed a pooled prevalence of 46.3% (ER = 0.463, 95%CI = 0.348–0.582,
n = 2) and 10.8% (ER = 0.108, 95%CI = 0.025–0.368, n = 2) for case–control and retrospective
cohort studies, respectively. High-dose glucocorticoid administration after SCI as well as
the injury itself appear to contribute to the development of AI. Conclusions: The estimated
prevalence of AI in people with traumatic SCI was high (24%). Prevalence was also greater
among individuals with cervical SCI than those with lower-level lesions. Clinicians should
be vigilant in recognizing the symptomatology and onset of SCI-AI. Further research elucidating
its underlying pathophysiology is needed to optimize glucocorticoid administration
for remediating AI in this vulnerable population.
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| Subject | |
| Genre | |
| Type | |
| Language |
eng
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| Date Available |
2025-05-08
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| Provider |
Vancouver : University of British Columbia Library
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| Rights |
CC BY 4.0
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| DOI |
10.14288/1.0448805
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| URI | |
| Affiliation | |
| Citation |
Journal of Clinical Medicine 14 (7): 2141 (2025)
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| Publisher DOI |
10.3390/jcm14072141
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| Peer Review Status |
Reviewed
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| Scholarly Level |
Faculty; Researcher
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| Rights URI | |
| Aggregated Source Repository |
DSpace
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CC BY 4.0