Đặc điểm lâm sàng, cận lâm sàng của bệnh nhân suy thượng thận do glucocorticoids tại Bệnh viện Đa khoa Bắc Kạn

Abstract

Background: Glucocorticoid-induced adrenal insufficiency (GIAI) is a frequent complication resulting from prolonged or inappropriate glucocorticoid use, leading to suppression of the hypothalamic–pituitary–adrenal (HPA) axis. This condition poses risks of metabolic, cardiovascular, and infectious complications. In Vietnam, the incidence of GIAI tends to increase. At Bac Kan General Hospital, patients with drug-induced adrenal insufficiency are treated. The use of many drugs of unknown origin containing glucocorticoids is quite arbitrary, so drug-induced adrenal insufficiency is a common health problem, a significant disease burden for the health care system. Objective: To describe the clinical and subclinical characteristics and identify factors associated with treatment response among patients with GIAI at Bac Kan General Hospital. Subject and method: A cross-sectional descriptive study was conducted on 45 patients diagnosed with acute or chronic exacerbations of GIAI hospitalized between July 2024 and July 2025. Result: The mean age was 68.4 ± 11.5 years, with females accounting for 57.8%. The most common underlying diseases requiring glucocorticoids were musculoskeletal disorders (51.1%). Medium-acting glucocorticoids were predominantly used (84.4%), with 66.7% taking them continuously and 44.4% using multiple administration routes. Clinically, fatigue (97.8%) and Cushingoid features (95.6%) were the most frequent symptoms. Hyponatremia occurred in 44.4% of patients, while serum potassium remained normal in all cases. Infection (51.1%) and poor treatment adherence (55.6%) were the main precipitating factors for adrenal crisis. The average hospital stay was significantly longer in infected patients (9.3 ± 1.9 days) than in non-infected ones (5.9 ± 2.5 days, p<0.0001). Conclusion: GIAI commonly affects elderly female patients with prolonged glucocorticoid exposure. Infections and poor adherence are key triggers of adrenal crises, with infections significantly prolonging hospitalization. Strengthening patient education and infection control is crucial to improve treatment outcomes.