The Prevalence of Adrenal Insufficiency in Individuals with Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Inclusion/Exclusion Criteria
2.3. Quality Appraisal
2.4. Data Extraction
2.5. Data Synthesis and Analyses
3. Results
3.1. Screening
3.2. Study Quality
3.3. Participant Characteristics
3.4. Glucocorticoid Administration
3.5. Adrenal Insufficiency
3.6. Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ACTH | Adrenocorticotropic hormone |
AI | Adrenal insufficiency |
AIS | American Spinal Injury Association Impairment Scale |
ALS | Amyotrophic lateral sclerosis |
CRH | Corticotropin-releasing hormone |
ER | Even rate |
HPA | Hypothalamic–pituitary–adrenal |
NLI | Neurological level of injury |
OR | Odds ratio |
SCI | Spinal cord injury |
SCI-AI | Spinal cord injury-related adrenal insufficiency |
SMA | Spinal muscular atrophy |
TSI | Time since injury |
95%CI | 95% confidence intervals |
95%PI | 95% prediction intervals |
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Author (Year) | Study Design | SCI-AI Prevalence | Event Rate | Participant Characteristics | Glucocorticoids/Mineralocorticoid | Adrenal Insufficiency | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
SCI (n = 545)/Control (n = 42) | Sex | Age | Neurological Level of Injury | Classification Based on AIS | Recovery Stage | Time Since Injury (Years) | Glucocorticoids or Mineralocorticoid (Before AI) | Name | Dose | Onset | Signs/Symptoms | SCI-AI Location/Level Affected | ||||
[32] (Baird-Howell & Wurzel, 2011) | Case report | N/A | N/A | SCI (n = 1) | Male | 41 | T2 | N/A | Chronic | 20 | N/A | N/A | N/A | 20 years after SCI (Admission: urinary tract infection) | Gastrointestinal bleeding, death, renal failure, amyloidosis | Primary |
[33] (Garcia-Zozaya, 2006) | Case report | N/A | N/A | SCI (n = 1) | Male | 21 | C6 | Grade A | Acute | N/A | Glucocorticoids | Methylprednisolone | Bolus 30 mg/kg over 15 min, with maintenance infusion of 5.4 mg/kg per hour for 23 h | 2 weeks after SCI | Hypotension resistant to vasopressor and volume resuscitation therapy | Tertiary |
[42] (Huang et al., 1998) | Case–control study | 11/25 | 0.440 | SCI (n = 25); Control (n =25) | Male | Range: 18–55 (mean: 35.4) | C5–C8 (n = 9) T1–L2 (n = 16) | N/A | Chronic | 1.1–15.8 (mean 35.4) | N/A | N/A | N/A | N/A | N/A | Primary |
[34] (Ishiki et al., 2024) | Case report | N/A | N/A | SCI (n = 1) | Female | 34 | C7 | Grade C | Acute | N/A | N/A | N/A | N/A | 12 days after SCI | No AI-related symptoms; hyperkalemia, slight hyponatremia | Secondary Pituitary |
[35] (Lecamwasam et al., 2004) | Case report | N/A | N/A | SCI (n = 1) | Male | 23 | C5 | N/A | Acute | N/A | Glucocorticoids | Dexamethasone, Methylprednisolone | Dexamethasone: 560 mg followed by 100 mg per hour for 6 h intravenously Methylprednisolone: 5.4 mg/kg per hour for 23 h intravenously | 4 days after steroid cessation | fever, hypotension, low basal cortisol | Tertiary |
[36] (Lee & Glenn, 2000) | Case report | N/A | N/A | SCI (n = 1) | Male | 51 | C5 | Grade C | Chronic | 8 | A synthetic progestin with glucocorticoid-like activity | Megestrol acetate | 200 mg by mouth, twice per day for 5 months | 8 years after SCI (Admission: difficulty with bladder catheterization and left flank pain possibly caused by a left kidney stone) | Mild hypotension, sinus tachycardia, hypoglycemia, hyponatremia | Secondary |
[37] (Lee et al., 2002) | Case–control study | 20/42 | 0.476 | SCI (n = 42); Control (n =17) | Male | Mean (SD): 40.5 (7.8) | N/A | Grade A or B | Chronic | >1 | N/A | N/A | N/A | N/A | Relatively larger adrenal volume than healthy individuals | Secondary |
[38] (Park & Cho, 2016) | Retrospective cohort | 12/228 (Treated with large-dose glucocorticoid = 10; not treated with large-dose glucocorticoid = 2) | 0.053 | SCI (n = 228) | Patients diagnosed with AI: Male (n = 10), Female (n = 2) | Range: 20–81 | Patients who have suspected AI: C3–C5 (n = 23) T6–T12 (n = 6) Patients diagnosed with AI: C3–C7 (n = 11) T10 (n = 1) | Patients diagnosed with AI: Grade A (n = 2), Grade C (n = 2), Grade D (n = 8) | NA | N/A | Glucocorticoids | N/A | Large dose | N/A | Fatigue, hypotension, anorexia | Secondary/Tertiary |
[39] (Pastrana et al., 2012) | Retrospective cohort | 8/37 | 0.216 | SCI (n = 199) SCI patients with neurogenic shock (n = 37) | NA | Range: 18–66 (mean: 32.3) | All patients: Cervical level (n = 199) Patients diagnosed with AI: C4–C5 (n = 8) | Grade A (n = 8) | Acute | N/A | N/A | N/A | N/A | N/A | Low cortisol, hypotension, neurogenic shock | NA |
[40] (Steinberg et al., 1978) | Case report | N/A | N/A | SCI (n = 1) | Male | 15 | C5 | N/A | Acute | N/A | N/A | N/A | N/A | 2 months after SCI | Hypercalcemia, orthostatic hypotension, low plasma cortisol level | Primary |
[41] (Wang & Huang, 1999) | Case series (same data as Lee (2002), excluded from meta-analysis) | 20/42 | 0.476 | SCI (n = 42) | Male | Range: 20–60 (mean: 39.2) | All patient: Cervical level (n = 17) Thoracolumbar level (n = 25) Patients diagnosed with AI: C4–C6 (n = 7) T3–T12 (n = 13) | Grade A or B | Chronic | 1.1–35 (mean 9.4) | N/A | N/A | N/A | N/A | Decreased adrenal reserve | Secondary |
[16] (Weant et al., 2008) | Case report | N/A | N/A | SCI (n = 2) | Male | 39, 75 | Case 1: C6 Case 2: C1 | N/A | Acute | N/A | Glucocorticoids | Case 1: Methylprednisolone; Case 2: N/A | N/A | Case 1: 23–31 days post-admission; Case 2: Day 6 | Case 1: low cortisol, fever;Case 2: hypotensive, not responsive to vasopressors | Secondary/Tertiary |
[17] (Yang et al., 2014) | Case report | N/A | N/A | SCI (n = 1) | Female | 61 | C3 | Grade D | Acute | N/A | Glucocorticoids | Dexamethasone | Dexamethasone intravenously for 11 days: 4 mg every 6 h for 18 doses 2 mg every 6 h for 5 doses 2 mg every 12 h for 7 doses | 2 days after steroid cessation | Low basal cortisol, acute neck pain, fatigue, muscle weakness, hypotension | Tertiary |
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Hosseinzadeh, A.; Hou, R.; Zeng, R.R.; Calderón-Juárez, M.; Lau, B.W.M.; Fong, K.N.K.; Wong, A.Y.L.; Zhang, J.J.; Sánchez Vidaña, D.I.; Miller, T.; et al. The Prevalence of Adrenal Insufficiency in Individuals with Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis. J. Clin. Med. 2025, 14, 2141. https://doi.org/10.3390/jcm14072141
Hosseinzadeh A, Hou R, Zeng RR, Calderón-Juárez M, Lau BWM, Fong KNK, Wong AYL, Zhang JJ, Sánchez Vidaña DI, Miller T, et al. The Prevalence of Adrenal Insufficiency in Individuals with Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2025; 14(7):2141. https://doi.org/10.3390/jcm14072141
Chicago/Turabian StyleHosseinzadeh, Ali, Rangchun Hou, Roy Rongyue Zeng, Martín Calderón-Juárez, Benson Wui Man Lau, Kenneth Nai Kuen Fong, Arnold Yu Lok Wong, Jack Jiaqi Zhang, Dalinda Isabel Sánchez Vidaña, Tiev Miller, and et al. 2025. "The Prevalence of Adrenal Insufficiency in Individuals with Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 14, no. 7: 2141. https://doi.org/10.3390/jcm14072141
APA StyleHosseinzadeh, A., Hou, R., Zeng, R. R., Calderón-Juárez, M., Lau, B. W. M., Fong, K. N. K., Wong, A. Y. L., Zhang, J. J., Sánchez Vidaña, D. I., Miller, T., & Kwong, P. W. H. (2025). The Prevalence of Adrenal Insufficiency in Individuals with Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 14(7), 2141. https://doi.org/10.3390/jcm14072141