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Cited by 13Adrenal Hormones and DisordersDiabetes Management and ResearchElectrolyte and hormonal disorders

Frequency of adrenal insufficiency in patients with hypoglycemia in an emergency department: A cross-sectional study

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Kawahara, Tetsuya, Tsuji, Maiko, Tominaga, Naoki, Toyama, Nagahiro, Toda, Mikio·2022·Journal of the Endocrine Society
DOI 10.1210/jendso/bvac119PMC PMC9419498
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Abstract

Abstract Context In most patients presenting with hypoglycemia in emergency departments, the etiology of hypoglycemia is identified. However, it cannot be determined in approximately 10% of cases. Objective We aimed to identify the causes of unknown hypoglycemia, especially adrenal insufficiency. Methods In this cross-sectional study, we evaluated the etiology of hypoglycemia among patients in our emergency department with hypoglycemia (plasma glucose level < 70 mg/dL (3.9 mmol/L)] between April 1, 2016 and March 31, 2021 using a rapid adrenocorticotropic hormone (ACTH) test. Results There were 528 cases with hypoglycemia included [52.1% male; median age 62 years (range 19-92)]. The majority [389 (73.7%)] of patients were using antidiabetes drugs. Additionally, 33 (6.3%) consumed alcohol; 17 (3.2%) had malnutrition; 13 (2.5%), liver dysfunction; 12 (2.3%), severe infectious disease; 11 (2.1%), malignancy; 9 (1.7%), heart failure; 4 (0.8%), insulin autoimmune syndrome; 3 (0.6%), insulinoma; 2 (0.4%) were using hypoglycemia-relevant drugs; and 1 (0.2%) suffered from non-islet cell tumor. Rapid ACTH tests revealed adrenal insufficiency in 32 (6.1%). In those patients, serum sodium levels were lower (132 vs 139 mEq/L, P < 0.01), eosinophil counts were higher (14 vs 8%, P < 0.01), and systolic blood pressure was lower (120 vs 128 mmHg, P < 0.05) at baseline than in patients with the other etiologies. Conclusion The frequency of adrenal insufficiency as a cause of hypoglycemia was much higher than what we anticipated. When protracted hypoglycemia of unknown etiology is recognized, we recommend that the patient is checked for adrenal function using a rapid ACTH test.

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  • A study in Japan diagnosed adrenal insufficiency in 32 out of 528 patients (6%) after presenting to the emergency department with hypoglycaemia.

    “A study in Japan diagnosed adrenal insufficiency in 32 out of 528 patients (6%) after presenting to the emergency department with hypoglycaemia.”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [36]

  • In a Japanese study, 6% of patients who sought emergency medical care due to hypoglycemia-related symptoms were diagnosed with AI.

    “In a Japanese study, researchers found that 6% of patients who sought emergency medical care due to hypoglycemia-related symptoms were diagnosed with AI [31].”

    From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [31]

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Authors
Kawahara, T., Tsuji, M., Tominaga, N., Toyama, N., & Toda, M.
Affiliations
  • Department of Endocrinology and Diabetes, Shinkomonji Hospital , Kitakyushu , Japan
  • Department of Emergency Medicine, Shinkomonji Hospital , Kitakyushu , Japan
  • Department of Internal Medicine, Shinkomonji Hospital , Kitakyushu , Japan
Corresponding author
Kawahara, Tetsuya
ORCID
Venue
Journal of the Endocrine Society
Publisher
The Endocrine Society
Published
2022-08-04
Volume
6
Issue
10
Pages
bvac119-bvac119
ISSN
2472-1972 (ISSN-L)
DOI
10.1210/jendso/bvac119
PMC
PMC9419498
OpenAlex
W4289704637
Cited by
13
References
47
Citations by year
2026: 5 · 2025: 2 · 2024: 4 · 2023: 2
FWCI
1.48
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the Endocrine Society (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
Kitakyushu Medical Association
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
Keywords
adrenal insufficiency, hypoglycemia, emergency department, insulin autoimmune syndrome, insulinoma, eosinophilia, hyponatremia, hypotension

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