Clinical features of primary adrenal insufficiency depending on age and disease duration Clinical features of primary adrenal insufficiency depending on age and disease duration

Relevance: Primary adrenal insufficiency (PAI) is a rare but clinically significant endocrine disease characterized by nonspecific clinical manifestations and difficulties in early diagnosis. Studying the clinical features of PAI with consideration of age, disease duration and disease dynamics against the background of replacement therapy is of substantial importance for optimizing diagnostic and therapeutic approaches.

Aim of the study: To characterize the clinical features of primary adrenal insufficiency with consideration of age, disease duration and the dynamics of the clinical course during prospective follow-up.

Materials and methods: A retrospective-prospective analysis was conducted in 100 patients with primary adrenal insufficiency who received outpatient and inpatient treatment at a specialized endocrinology center during 2017–2024. The assessment included analysis of complaints, medical history data, anthropometric indicators, arterial blood pressure, disease duration, frequency of Addisonian crises and concomitant pathology. The prospective stage involved dynamic monitoring of patients against the background of replacement therapy. Statistical processing of the data was performed using descriptive statistics and the χ² test. Differences were considered statistically significant at p<0.05.

Results: The mean age of the patients was 36.4 ± 17.1 years, the mean body weight was 62.3 ± 13.2 kg, and the mean height was 1.66 ± 0.08 m. The mean disease duration was 5.3 ± 7.1 years, reflecting pronounced heterogeneity of the studied cohort. Women predominated in the gender structure (68%), while men accounted for 32%. Analysis of body mass index revealed a predominance of normal and reduced values, with underweight recorded in approximately 30% of patients. The clinical picture of PAI was characterized by marked polymorphism. The most frequent clinical manifestations were asthenic syndrome (≈95%), arterial hypotension (≈90%), skin hyperpigmentation (≈85%) and weight loss (≈75%). Dizziness, dyspeptic disorders and increased craving for salt were also recorded. The statistical analysis revealed a significant association between key clinical signs, particularly between arterial hypotension and hyperpigmentation (p<0.05). In patients with disease duration of less than 1 year, clinical manifestations were more pronounced compared with patients with a long-term course of the disease (p<0.05). According to the results of prospective follow-up, adequate replacement therapy was associated with a statistically significant improvement in the clinical condition of patients, including reduced severity of asthenic syndrome and stabilization of arterial blood pressure. The frequency of Addisonian crises significantly decreased with adherence to the treatment regimen (p<0.05).