Delayed Diagnosis of Adrenal Insufficiency Is Common: A Cross-Sectional Study in 216 Patients
Delayed Diagnosis of Adrenal Insufficiency Is Common: A Cross-Sectional Study in 216 Patients
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DOI：
10.1097/maj.0b013e3181db6b7a
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发表时间：
2010-06-01
影响因子：
3.1
通讯作者：
Quinkler, Marcus
中科院分区：
文献类型：
--
作者：
Bleicken, Benjamin;Hahner, Stefanie;Quinkler, Marcus
简介：关于肾上腺功能不全（AI）患者在诊断前的主诉、正确诊断前的时间、假诊断和因诊断而改变专业的信息很少。目的：我们回顾性评估的情况下，在诊断前和在原发性和继发性AI患者的AI使用既定的医院焦虑和抑郁量表，简表-36和Giessen投诉列表（GBB-24）的问卷调查，和一个自我建立的一般登记表。方法：在这项横断面研究中，问卷集来自216例患者（原发性AI，n = 99;继发性AI，n = 117）。通过问卷调查和病历回顾验证治疗前的时间、基础诊断和疾病症状。主观健康状况（SHS）的结果进行了比较与性别和年龄匹配的控制来自特定的参考队列。结果：不到30%的女性和50%的男性AI在症状发作后的前6个月内被诊断。20%的患者在被诊断前患有>5年。超过67%的患者咨询了至少3名医生，68%的患者主要是误诊。最常见的错误诊断是精神和胃肠道的起源。总的来说，与对照组相比，AI患者显示出受损的SHS，并且在3个月内被正确诊断的患者显示出明显更好的SHS。结论：由于临床症状不特异，常延误诊断、漏诊或误诊。早期诊断是必要的，并可能对AI患者的SHS产生积极影响。
Introduction: Little information is available on patients with adrenal insufficiency (AI) in regard to complaints before diagnosis, time until correct diagnosis, false diagnosis, and professional changes due to the diagnosis. Objective: We retrospectively evaluated circumstances before and at diagnosis of AI in patients with primary and secondary AI by using established Hospital Anxiety and Depression Scale, Short Form-36 and Giessen Complaint List (GBB-24) questionnaires, and a self-established general registration form. Methods: In this cross-sectional study, questionnaire sets were available from 216 patients (primary AI, n = 99; secondary AI, n = 117). Time duration before treatment, underlying diagnoses, and disease symptoms were verified by questionnaires and review of medical records. Results regarding subjective health status (SHS) were compared with sex- and age-matched controls drawn from questionnaire-specific reference cohorts. Results: Less than 30% of woman and 50% of men with AI were diagnosed within the first 6 months after onset of symptoms. Twenty percent of patients suffered >5 years before being diagnosed. More than 67% of patients consulted at least 3 physicians, and 68% were primarily false diagnosed. The most common false diagnoses were of psychiatric and gastrointestinal origin. Overall, patients with AI showed an impaired SHS compared with controls, and patients who were diagnosed correctly within 3 months showed a significantly better SHS. Conclusions: Because of the unspecific symptoms, diagnosis is often delayed, not recognized by physicians or diagnosed falsely. An early diagnosis is necessary and might positively influence SHS in patients with AI.