Adrenal Insufficiency in Acute Spinal Cord Injury

J Spinal Cord Med, 2006 · DOI: · Published: January 1, 2006

Simple Explanation

Adrenal insufficiency makes it harder for the body to handle the stress of being sick. It can be hard to spot because the symptoms, like feeling weak, losing weight, and low blood pressure, can be caused by many things. It's even harder to diagnose in people with spinal cord injuries because they often have other health problems and their bodies don't respond to stress in the usual way. This report discusses a young man with a recent spinal cord injury who also developed adrenal insufficiency. During recovery, the patient had two instances where infections made his adrenal insufficiency worse, requiring increased steroid medication to manage symptoms like low blood pressure and weakness.

Study Duration

Not specified

Participants

21-year-old man with C6 American Spinal Injury Association A spinal cord injury

Evidence Level

Case report

Key Findings

1
The patient developed symptomatic hypotension resistant to vasopressors and volume replacement 2 weeks after injury and was diagnosed with adrenal insufficiency.
2
Secondary adrenal insufficiency complicated the patient's medical and rehabilitative course after a spinal cord injury.
3
During two infectious episodes, the patient's hydrocortisone dosage had to be doubled to control symptoms like hypotension, lethargy, weakness, and anorexia.

Research Summary

This case report describes a 21-year-old man with a C6 spinal cord injury who developed adrenal insufficiency two weeks after the injury. The patient's adrenal insufficiency complicated his rehabilitation, requiring increased hydrocortisone during infectious episodes to manage hypotension, lethargy, weakness, and anorexia. The authors conclude that adrenal insufficiency should be considered in SCI patients with unexplained volume depletion and vascular collapse, but that the non-specific symptoms can be easily mistaken for other conditions commonly found in this patient population.

Practical Implications

Increased Clinical Suspicion

Clinicians should maintain a high index of suspicion for adrenal insufficiency in both acute and chronic SCI patients due to the overlap of symptoms with other common SCI complications.

Screening Tool

Cortisol values could potentially be used as a screening tool for impaired adrenal function in acute SCI, prompting further investigation with cosyntropin testing for those with very low levels.

Individualized Steroid Treatment

Steroid treatment in SCI patients should be individualized based on the patient's clinical situation due to the undetermined understanding of adrenal response to life-threatening stress in SCI.

Study Limitations

1
Single case report limits generalizability.
2
The study did not determine to what extent and how early the SCI contributed to the development of adrenal insufficiency.
3
The presence of preexisting subclinical adrenal insufficiency cannot be excluded.

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