Risk factors that are associated with adrenal insufficiency among patients with fever of unknown origin

ABSTRACT

Background

Adrenal insufficiency is one of the causes of fever of unknown origin (FUO). The purpose of this study is to find out risk factors that are associated with adrenal insufficiency in FUO patients.

Methods

This study was conducted retrospectively in a tertiary hospital with 846 beds in South Korea. All adult inpatients (age ≥19 years) who have requested a consult with the department of infectious disease for FUO between 1 July 20191 July 2019 and 30 June 202030 June 2020 were included in the study. Among them, those who underwent an adrenocorticotropic hormone (ACTH) stimulation test and had a fever of 37.8°C or higher within 48 hours of the ACTH stimulation test were finally included in the study subjects.

Results

A total of 202 FUO patients were enrolled and 61 (30.1%) were finally diagnosed with adrenal insufficiency. In a multivariate analysis, use of immunosuppressant within 3 months (OR 6.06, 95% CI 1.82–20.13, P = 0.003), use of corticosteroid within 3 months (OR 8.23, 95% CI 1.35–50.17, P = 0.022), sodium ≥ 136.7 (OR 3.43, 95% CI 1.49–7.88, P = 0.004), and calcium ≥ 8.4 (OR 0.31, 95% CI 0.14–0.71, P = 0.005) were proven to be factors associated with adrenal insufficiency in FUO patients.

Conclusion

In conclusion, 30.1% of FUO patients were diagnosed with adrenal insufficiency. The risk factors that are associated with adrenal insufficiency in FUO patients were immunosuppressive prescription or systemic steroid prescription within 3 months, or with sodium ≥ 136.7 or calcium < 8.4.

KEYWORDS:

• Adrenal insufficiency
• fever
• ACTH stimulation test
• fever of unknown origin
• diagnosis

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The abstract of this article was presented at the poster session of IDWeek 2022, Washington, DC, USA.

Author contributions

Conceptualization: Kim B, Park JH. Data curation: Ko JW, Lee SE. Formal analysis: Ko JW, Lee SE. Investigation: Ko JW, Lee SE, Kim B. Methodology: Ko JW, Lee SE, Kim B, Park JH. Project administration: Kim B, Park JH. Resources: Park JH. Software: Ko JW, Lee SE. Supervision: Kim B. Validation: Kim B. Visualization: Ko JW, Lee SE. Writing – original draft: Ko JW. Writing – review & editing: Kim B.

Additional information

Funding

This paper was not funded.