Endocrine Abstracts

Background: Syncope and pre-syncope are well recognised symptoms of primary adrenal insufficiency (AI). Some guidelines⁽¹⁾ recommend screening for AI in all patients who present with symptoms of orthostatic intolerance. However, the incidence of AI in these patients is unknown.

Aims: The aim of the study was to determine the incidence of AI in patients referred to a cardiac autonomic dysfunction clinic at a single tertiary care centre.

Methods: This was a retrospective cohort study of all new consecutive patients referred to cardiac autonomic dysfunction clinics between November- December 2022 at Sheffield Teaching Hospitals. Electronic case notes were reviewed to collect data on demographics, final underlying diagnosis (i.e., postural orthostatic tachycardia syndrome [POTS], postural hypotension, reflex syncope or others), and the incidence of AI.

Results: A total of 180 new patients were referred and reviewed in cardiac autonomic dysfunction clinic during the study period. Mean ± SD age of the study population was 45.2 ± 21.0 years with 61% (n=109) females. After investigations and review, 30% (n=54) were diagnosed with postural hypotension, while POTS was diagnosed in 3.9% (n=7) of patients. Diagnosis of reflex syncope was made in 17.8% (n=32) of the patients and 48.3% of patients (n=87) had a diagnosis other than above categories. Of all these patients 50% (n=90) were screened for AI, but only 1 patient who also had pre-syncopal symptoms was found to have AI secondary to opioid overuse and remains under endocrine review.

Conclusion: Despite the similarity in symptoms, the incidence of AI in patients referred to autonomic dysfunction clinics is very low. The need to screen for AI in this patient group is debatable.

Reference: ⁽¹⁾ Raj et al. Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance. Can J Cardiol. 2020 Mar;36(3):357-372. doi: 10.1016/j.cjca.2019.12.024