Digestive Manifestations of Secondary Adrenal Insufficiency

Secondary adrenal insufficiency (SAI) is a condition characterized by the impairment of the hypothalamic-pituitary-adrenal axis, resulting from deficiency in adrenocorticotropic hormone (ACTH) secretion. One of the common manifestations of SAI is digestive symptoms, which can have a significant impact on quality of life.

Digestive symptoms, such as abdominal pain, nausea, and vomiting, are thought to be a direct consequence of glucocorticoid and mineralocorticoid deficiency. These symptoms can be non-specific and may lead to misdiagnosis of an acute abdomen. In addition, they can be incapacitating, with 40%, 47%, and 33% of patients with primary adrenal insufficiency (PAI), SAI, and congenital adrenal hyperplasia (CAH) respectively reporting abdominal pain at least once a week over the past three months.

The prevalence of digestive symptoms in CAI patients is significant, with 30% of patients experiencing symptoms similar to those of irritable bowel syndrome. In fact, quality of life was reported as poor or very poor in 35%, 57%, and 24% of patients respectively, compared to 5% of controls.

Assessment and management of digestive symptoms are crucial for physicians treating patients with CAI. The Rome IV criteria for functional bowel disorders were used to analyze responses from 119 patients with adrenal insufficiency, including 68 with PAI, 30 with SAI, and 21 with CAH, as well as 33 control subjects.

In conclusion, digestive symptoms are a common manifestation of secondary adrenal insufficiency, and their assessment and management should be considered a priority for physicians treating these patients. Further research is needed to fully understand the mechanisms underlying these symptoms and to develop effective treatment strategies.