Adrenal Abscesses: A Systematic Review of the Literature
<b>Objective:</b> To summarize the existing knowledge about adrenal gland abscesses, including etiology, clinical presentation, common laboratory and imaging findings, management and overall morbidity and mortality. <b>Design:</b> Systematic literature review. <b>Method...
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MDPI AG
2023-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/14/4601 |
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| author | Nikola Gligorijevic Marija Kaljevic Natasa Radovanovic Filip Jovanovic Bojan Joksimovic Sandra Singh Igor Dumic |
| author_facet | Nikola Gligorijevic Marija Kaljevic Natasa Radovanovic Filip Jovanovic Bojan Joksimovic Sandra Singh Igor Dumic |
| author_sort | Nikola Gligorijevic |
| collection | DOAJ |
| description | <b>Objective:</b> To summarize the existing knowledge about adrenal gland abscesses, including etiology, clinical presentation, common laboratory and imaging findings, management and overall morbidity and mortality. <b>Design:</b> Systematic literature review. <b>Methods:</b> We performed a search in the PubMed database using search terms: ‘abscess and adrenal glands’, ‘adrenalitis’, ‘infection and adrenal gland’, ‘adrenal abscess’, ‘adrenal infection’ and ‘infectious adrenalitis’. Articles from 2017 to 2022 were included. We found total of 116 articles, and after applying exclusion criteria, data from 73 articles was included in the final statistical analysis. <b>Results:</b> Of 84 patients included in this review, 68 were male (81%), with a mean age of 55 years (range: 29 to 85 years). Weight loss was the most frequent symptom reported in 58.3% patients, followed by fever in 49%. Mean duration of symptoms was 4.5 months. The most common laboratory findings were low cortisol (51.9%), elevated ACTH (43.2%), hyponatremia (88.2%) and anemia (83.3%). Adrenal cultures were positive in 86.4% cases, with <i>Histoplasma capsulatum</i> (37.3%) being the leading causative agent. Blood cultures were positive in 30% of patients. The majority of the adrenal infections occurred through secondary dissemination from other infectious foci and abscesses were more commonly bilateral (70%). A total of 46.4% of patients developed long-term adrenal insufficiency requiring treatment. Abscess drainage was performed in 7 patients (8.3%) and adrenalectomy was performed in 18 (21.4%) patients. The survival rate was 92.9%. Multivariate analysis showed that the only independent risk factor for mortality was thrombocytopenia (<i>p</i> = 0.048). <b>Conclusion:</b> Our review shows that adrenal abscesses are usually caused by fungal pathogens, and among these, <i>Histoplasma capsulatum</i> is the most common. The adrenal glands are usually involved in a bilateral fashion and become infected through dissemination from other primary sources of infection. Long-term adrenal insufficiency develops in 46% of patients, which is more common than what is observed in non-infectious etiology of adrenal gland disorders. Mortality is about 7%, and the presence of thrombocytopenia is associated with worse prognosis. Further prospective studies are needed to better characterize optimal testing and treatment duration in patients with this relatively rare but challenging disorder. |
| first_indexed | 2024-03-11T00:58:53Z |
| format | Article |
| id | doaj.art-9bdb1ea8b67a4a8e906ccc69770372f8 |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T00:58:53Z |
| publishDate | 2023-07-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-9bdb1ea8b67a4a8e906ccc69770372f82023-11-18T19:51:12ZengMDPI AGJournal of Clinical Medicine2077-03832023-07-011214460110.3390/jcm12144601Adrenal Abscesses: A Systematic Review of the LiteratureNikola Gligorijevic0Marija Kaljevic1Natasa Radovanovic2Filip Jovanovic3Bojan Joksimovic4Sandra Singh5Igor Dumic6Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USADepartment of Hospital Medicine, Saint Francis Hospital and Medical Center, Hartford, CT 06105, USADepartment of Endocrinology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USADepartment of Internal Medicine, Merit Health Wesley, Hattiesburg, MS 39402, USADepartment of Pathological Physiology, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and HerzegovinaClinic for Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, 11000 Belgrade, SerbiaDepartment of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA<b>Objective:</b> To summarize the existing knowledge about adrenal gland abscesses, including etiology, clinical presentation, common laboratory and imaging findings, management and overall morbidity and mortality. <b>Design:</b> Systematic literature review. <b>Methods:</b> We performed a search in the PubMed database using search terms: ‘abscess and adrenal glands’, ‘adrenalitis’, ‘infection and adrenal gland’, ‘adrenal abscess’, ‘adrenal infection’ and ‘infectious adrenalitis’. Articles from 2017 to 2022 were included. We found total of 116 articles, and after applying exclusion criteria, data from 73 articles was included in the final statistical analysis. <b>Results:</b> Of 84 patients included in this review, 68 were male (81%), with a mean age of 55 years (range: 29 to 85 years). Weight loss was the most frequent symptom reported in 58.3% patients, followed by fever in 49%. Mean duration of symptoms was 4.5 months. The most common laboratory findings were low cortisol (51.9%), elevated ACTH (43.2%), hyponatremia (88.2%) and anemia (83.3%). Adrenal cultures were positive in 86.4% cases, with <i>Histoplasma capsulatum</i> (37.3%) being the leading causative agent. Blood cultures were positive in 30% of patients. The majority of the adrenal infections occurred through secondary dissemination from other infectious foci and abscesses were more commonly bilateral (70%). A total of 46.4% of patients developed long-term adrenal insufficiency requiring treatment. Abscess drainage was performed in 7 patients (8.3%) and adrenalectomy was performed in 18 (21.4%) patients. The survival rate was 92.9%. Multivariate analysis showed that the only independent risk factor for mortality was thrombocytopenia (<i>p</i> = 0.048). <b>Conclusion:</b> Our review shows that adrenal abscesses are usually caused by fungal pathogens, and among these, <i>Histoplasma capsulatum</i> is the most common. The adrenal glands are usually involved in a bilateral fashion and become infected through dissemination from other primary sources of infection. Long-term adrenal insufficiency develops in 46% of patients, which is more common than what is observed in non-infectious etiology of adrenal gland disorders. Mortality is about 7%, and the presence of thrombocytopenia is associated with worse prognosis. Further prospective studies are needed to better characterize optimal testing and treatment duration in patients with this relatively rare but challenging disorder.https://www.mdpi.com/2077-0383/12/14/4601adrenal abscessadrenal infectionadrenal insufficiencyhistoplasmosis |
| spellingShingle | Nikola Gligorijevic Marija Kaljevic Natasa Radovanovic Filip Jovanovic Bojan Joksimovic Sandra Singh Igor Dumic Adrenal Abscesses: A Systematic Review of the Literature Journal of Clinical Medicine adrenal abscess adrenal infection adrenal insufficiency histoplasmosis |
| title | Adrenal Abscesses: A Systematic Review of the Literature |
| title_full | Adrenal Abscesses: A Systematic Review of the Literature |
| title_fullStr | Adrenal Abscesses: A Systematic Review of the Literature |
| title_full_unstemmed | Adrenal Abscesses: A Systematic Review of the Literature |
| title_short | Adrenal Abscesses: A Systematic Review of the Literature |
| title_sort | adrenal abscesses a systematic review of the literature |
| topic | adrenal abscess adrenal infection adrenal insufficiency histoplasmosis |
| url | https://www.mdpi.com/2077-0383/12/14/4601 |
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