Adrenal Insufficiency in Systematic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS): A Systematic Review

Publication date: Available online 5 November 2018

Source: Autoimmunity Reviews

Author(s): Keum Hwa Lee, HyunJeong Lee, Cheol-hun Lee, Jin Yeong Kim, Jong Min Kim, Se Seung Kim, Seungmin Jeong, In Sung Hwang, Namsoo Kim, Na Eun Kim, Soogeun Shin, Dongkwan Shin, Joo Sang Song, Dong Hyun Shin, Jung Dong Kim, Jeehoon Kim, Yong Seok Lee, Hansung Kang, Dong Ha Kim, So Hyun Moon

Abstract

Background: Adrenal insufficiency (AI) is associated with high morbidity and mortality. The aim of this systematic review was to enhance diagnostic approaches and summarize therapeutic strategies in the management of AI in patients with an underlying prior disease history.

Methods: A literature search of PubMed and EMBASE databases was performed and 91 publications containing 105 cases were included for the final analysis.

Results: The following frequency of clinical signs and symptoms was noted: abdominal pain (39.04%) was the leading symptom, followed by fever (33.33%), vomiting (23.81%), and nausea (19.05%). Antiphospholipid syndrome (APS) was present in 73%, systematic lupus erythematosus (SLE) in 17% of the patients, while 2% had a diagnosis of both, SLE and APS. ACTH stimulation test (ACTHst) was performed in 18% of cases and 76.6% of them were unresponsive towards stimulation. Variable treatment approaches were used: hydrocortisone was most commonly used (38.09%), followed by fludrocortisone (26.67%), prednisolone (20.00%) and volume replacement treatment (11.43%), respectively.

Conclusions: This analysis highlights the importance of an early diagnosis and initiation of therapeutic management when AI is suspected. In line, signs and symptoms related to autoimmune diseases in patients with AI should be reviewed crtitically.

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