The role of General Practitioner in the recognition of adrenal insufficiency

Marta Dudzińska, Agnieszka Zwolak, Joanna Malicka, Joanna Świrska, Ewa Kiszczak-Bochyńska, Robert Jan Łuczyk, Robert Zwolak, Jadwiga Daniluk, Jerzy Tarach

Abstract


Background. Addison's disease (AD), usually caused by an autoimmune process, has non-specific symptomatology. The deficiency of cortisol is manifested by weakness, anorexia, weight loss and orthostatic hypotension.  Early recognition is crucial as acute adrenal insufficiency is a life threatening state.

Objectives. Analysis of the clinical picture, occurrence of symptoms before diagnosis, and the role of General Practitioner (GP) in the diagnosis of AD.

Material and methods. 23 patients with primary adrenal insufficiency (18F, 5M, aged 24-80 years, with an average of 46,6 years). A method of proprietary questionnaire was used.

Results. The symptoms present prior to diagnosis were as follows: weakness (100% of patients, approximately 9,2 months before the diagnosis), fatigue (100%; 8,8 months respectively), loss of appetite (95,6%; 9,1 months), skin darkening (95,6%; 10 months), orthostatic hypotension (91,3%; 10,7 months), weight loss (86,9%; 6,8 months), low blood pressure (73,9%; 11 months), stomachache (69,6%; 4,6 months), nausea (65,2%; 3,6 months), increased appetite for salt (56,5%; 6,2 months), muscle pain (52,2%; 15,5 months), hyperpigmentation of buccal mucosa and gums (47,8%; 2,7 months), vomiting (43,5%; 3,4 months). Because of these symptoms patients went to different specialists, including GPs in 78,3% of cases. Suspicion of the disease in 34.8% put GP.

Conclusion. The symptoms of AD develop slowly and are present long time before the right diagnosis is established. Difficulties in early diagnosis may result from a low specificity of most of the symptoms. The role of GP in establishing the right and early diagnosis of Addison's disease is crucial.


Keywords


Addison's disease, acute adrenal insufficiency, General Practitioner

Full Text:

PDF (Polski)

References


Papierska L. Niedoczynność kory nadnerczy. W: Zgliczyński W. red. Endokrynologia cz.II, Wyd.I. Warszawa: Medical Tribune Polska, 2011

Papierska L. Autoimmune primary adrenal insufficiency. Progress in Medicine 2008; 21(2): 132–137.

Papierska L, Rabijewski M. Delay in diagnosis of adrenal insufficiency is a frequent cause of adrenal crisis. Int J Endocrinol 2013; http://dx.doi.org/10.1155/2013/482370

Bleicken B, Hahner S, Ventz M, et al. Delayed diagnosis of adrenal insufficiency is common: a cross-sectional study in 216 patients. Am J Med Sci. 2010; 339(6):525-531.

Bednarek-Tupikowska G. Choroby nadnerczy. W: Milewicz A. Endokrynologia Kliniczna T.2. Wrocław: Polskie Towarzystwo Endokrynologiczne; 2012.

Erichsen MM, Løv˚as K, Skinningsrud B, et al. Clinical immunological, and genetic features of autoimmune primary adrenal insufficiency: observations from a Norwegian registry. Journal of Clinical Endocrinology and Metabolism, 2009; 94(12): 4882–4890.

Zdrojowy-Wełna A, Bednarek-Tupikowska G. Postępowanie w przewlekłej niewydolności kory nadnerczy - rola lekarza rodzinnego. Fam Med Prim Care Rev 2013; 15(3); 486-490.




DOI: http://dx.doi.org/10.5281/zenodo.800719

Refbacks

  • There are currently no refbacks.




Copyright (c) 2017 Marta Dudzińska, Agnieszka Zwolak, Joanna Malicka, Joanna Świrska, Ewa Kiszczak-Bochyńska, Robert Jan Łuczyk, Robert Zwolak, Jadwiga Daniluk, Jerzy Tarach

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Journal of Education, Health and Sport formerly Journal of Health Sciences

Declaration on the original version.

Editors indicates that the main version of the magazine is to issue a "electronic".

The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019.

1223 Journal of Education, Health and Sport eISSN 2391-8306 7

ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

Archives 2011 - 2014

PBN 2011 - 2014

https://pbn.nauka.gov.pl/sedno-webapp/search?search&searchCategory=WORK&filter.inJournal=36616

POL-index 2011 - 2014

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-32a319c5-a850-4f44-ba70-1418a6087655

BASE 2011 - 2014

https://www.base-search.net/Search/Results?lookfor=Journal+of+Health+Sciences+%28Radom%29&type=all&oaboost=1&ling=1&name=&thes=&refid=dcrespl&newsearch=1

http://elibrary.ru/contents.asp?titleid=37467

http://journal.rsw.edu.pl/index.php/JHS/issue/archive

Indexed in Bases, Bazy indeksacyjne: ERIH Plus, Worldcat, PBN/POL-Index, ICI Journals Master List, Directory of Open Access Journals (DOAJ), ZBD, Ulrich's periodicals, Google Scholar, Polska Bibliografia Lekarska

US NLM = 101679844

101679844 - NLM Catalog Result - NCBI

https://www.ncbi.nlm.nih.gov/nlmcatalog/101679844

Find a library that holds this journal: http://worldcat.org/issn/23918306

Journal Language(s): English 

PBN Poland

https://pbn.nauka.gov.pl/sedno-webapp/journals/49068

POL-index

https://pbn.nauka.gov.pl/polindex-webapp/browse/journal/journal-c39c8169-88d2-45db-9e7f-d948ce9981c4

BASE

https://www.base-search.net/Search/Results?join=AND&bool0[]=AND&lookfor0[]=2391-8306&type0[]=all&page=11&l=pl&oaboost=1&refid=dcpagepl

Redaction, Publisher and Editorial Office

Instytut Kultury Fizycznej Uniwersytet Kazimierza Wielkiego w Bydgoszczy, Institute of Physical Education Kazimierz Wielki University in Bydgoszcz, Poland 85-091 Bydgoszcz ul. Sportowa 2  www.ukw.edu.pl Copyright by Instytut Kultury Fizycznej UKW w Bydgoszczy http://ojs.ukw.edu.pl/index.php/johs  Open Access ISSN 2391-8306 formerly ISSN: 1429-9623 / 2300-665X

The journal has been approved for inclusion in ERIH PLUS.

The ERIH PLUS listing of the journal is available at https://dbh.nsd.uib.no/publiseringskanaler/erihplus/periodical/info?id=485984

SIC Science citation index (calculated on the basis of TCI and Page Rank) 0

Russian Impact factor 0.16

Indexed in Index Copernicus Journals Master List.

http://journals.indexcopernicus.com/Journal+of+Education+Health+and+Sport,p24782242,3.html

ICV 2018 = 95.95 ICV 2017 = 91.30 ICV 2016 = 84.69 ICV 2015 = 93.34 ICV 2014 = 89.51 Standardized Value: 8.27 ICV 2013: 7.32 ICV 2012: 6.41 ICV 20115.48

The InfoBase Index IBI Factor for the year 2015 is 3.56 in InfoBase Index.com.

Website: www.infobaseindex.com

Universal Impact Factor 1.78 for year 2012. (http://www.uifactor.org/AppliedJournals.aspx)

Indexed in Polish Scholarly Bibliography (PBN) (PBN Polska Bibliografia Naukowa) (https://pbn.nauka.gov.pl/journals/36616)

is a portal of the Polish Ministry of Science and Higher Education, collecting information on publications of Polish scientists and on Polish and foreign scholarly journals. Polish Scholarly Bibliograhpy is a part of POL-on - System of Information on Higher Education. It is operated by the Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw.

Indexed in Russian Sciences Index Российский индекс научного цитирования (РИНЦ) http://elibrary.ru/contents.asp?titleid=37467

Indexed in Arianta Polish scientific and professional electronic journals Aneta Drabek i Arkadiusz Pulikowski

(http://www1.bg.us.edu.pl/bazy/czasopisma/czasop_full.asp?id=3595)