Digestive symptoms in daily life of chronic adrenal insufficiency patients are similar to irritable bowel syndrome symptoms

Abstract

Gastrointestinal symptoms are frequent in acute adrenal insufficiency. Although digestive symptoms can significantly reduce quality of life, they are rarely described in patients with treated chronic adrenal insufficiency (CAI). We aimed to characterize digestive symptoms in CAI patients. We used the section pertaining functional bowel disorders of the Rome IV questionnaire. A questionnaire was published on the website of the non-profit patient association “Adrenals” (NPPA of CAI patients) for five months. Information on demographics, characteristics of adrenal insufficiency, digestive symptoms and quality of life was collected. The relatives of CAI patients served as a control group. We analyzed responses of 33 control subjects and 119 patients (68 primary adrenal insufficiency (PAI), 30 secondary adrenal insufficiency (SAI) and 21 congenital adrenal hyperplasia (CAH)). Abdominal pain at least once a week over the past 3 months was reported by 40%, 47% and 33% of patients with PAI, SAI and CAH respectively versus 15% for the controls (p = 0.01). Symptoms were consistent with the Rome IV criteria for irritable bowel syndrome in 27%, 33% and 33% of patients respectively versus 6% for the controls (p < 0.0001). Quality of life was described as poor or very poor in 35%, 57% and 24% of patients respectively versus 5% for the controls (p < 0.0001). In conclusion, digestive symptoms are frequent and incapacitating in CAI patients and similar to symptoms of irritable bowel syndrome in 30% of CAI patients. Assessment and management of digestive symptoms should be considered a priority for physicians treating patients with CAI.

Review article: diagnostic and therapeutic approach to persistent abdominal pain beyond irritable bowel syndrome

“…Abdominal pain is one of the main clinical symptoms of adrenal insufficiency among other symptoms such as weakness, fatigue, anorexia, weight loss orthostatic hypotension and salt craving 37 . The nonspecific digestive symptoms, such as abdominal pain, sometimes lead to misdiagnosis of an acute abdomen 77 . These digestive manifestations are thought to be a direct consequence of glucocorticoid and mineralocorticoid deficiency, but the mechanism remains unclear 77 .…”

“…The nonspecific digestive symptoms, such as abdominal pain, sometimes lead to misdiagnosis of an acute abdomen 77 . These digestive manifestations are thought to be a direct consequence of glucocorticoid and mineralocorticoid deficiency, but the mechanism remains unclear 77 . In a cross‐sectional controlled study of 119 patients with chronic adrenal insufficiency, 40% of the study population reported abdominal pain at least once a week during the previous 3 months 77 .…”

“…These digestive manifestations are thought to be a direct consequence of glucocorticoid and mineralocorticoid deficiency, but the mechanism remains unclear 77 . In a cross‐sectional controlled study of 119 patients with chronic adrenal insufficiency, 40% of the study population reported abdominal pain at least once a week during the previous 3 months 77 . Symptoms were consistent with the Rome IV IBS criteria in 30% of patients with chronic adrenal insufficiency, and IBS‐like symptoms were significantly more frequent in patients with chronic adrenal insufficiency than in controls 77 .…”

“…In a cross‐sectional controlled study of 119 patients with chronic adrenal insufficiency, 40% of the study population reported abdominal pain at least once a week during the previous 3 months 77 . Symptoms were consistent with the Rome IV IBS criteria in 30% of patients with chronic adrenal insufficiency, and IBS‐like symptoms were significantly more frequent in patients with chronic adrenal insufficiency than in controls 77 . Assessment of adrenal insufficiency by cortisol measurement after tetracosactide is frequent in patients with inflammatory bowel disease after withdrawal of steroid therapy, and this diagnosis should be considered in case of abdominal pain in these patients 78 …”

Clinical Unmet Needs in the Treatment of Adrenal Crisis: Importance of the Patient’s Perspective

“…Part of the explanation could be the noradrenergic overstimulation, since the normal stress response is based on two pillars: the HPA-axis and the autonomic nervous system, of which only the first is deficient in AI, whereas the latter is intact (see Challenges in Current Treatment Strategies ) ( 35 ). Chronic gastrointestinal symptoms are more prevalent in AI patients compared to controls, being incapacitating and similar to symptoms of the irritable bowel syndrome in about 30% of patients ( 36 ). Diffuse limb and back pain are also frequently reported.…”