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DOI: https://doi.org/10.4235/agmr.23.0123    [Accepted]
Published online November 21, 2023.
Prevalence of Adrenal Insufficiency in Korean Patients undergoing Total Knee Arthroplasty
So Won Baek1, Jung Ho Noh2  , Yeon Sik Heo3
1Nursing Department, Kangwon National University Hospital, Chuncheon, Republic of Korea
2Department of Orthopaedic Surgery, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
3Department of Orthopaedic Surgery, Kangwon National University Hospital, Chuncheon, Republic of Korea
Correspondence:  Jung Ho Noh,
Email: bestknee@gmail.com
Received: 7 August 2023   • Revised: 29 October 2023   • Accepted: 14 November 2023
Abstract
Background
This study investigated the prevalence of adrenal insufficiency among patients admitted for total knee arthroplasty (TKA) due to osteoarthritis and identified factors contributing to adrenal insufficiency.
Methods
We divided the patients into two groups based on the results of preoperative standard-dose short synchronous stimulation tests: group 1 (adrenal insufficiency) and group 2 (normal adrenal function). We also assessed the prevalence of adrenal insufficiency and compared the numbers of patients who received oral steroids, the frequency of previous steroid injection use, and the frequency of systemic symptoms of steroid depletion such as fatigue and loss of appetite between the two groups. Multiple regression analysis was performed to identify factors related to adrenal insufficiency.
Results
The prevalence of adrenal insufficiency was 60.0% (120/200). Group 1 had higher numbers of previous steroid injections (12.8±10.2 vs. 6.8±7.9) and patients taking oral steroids (18/120 vs. 3/80) (p<0.001 and p=0.011, respectively). The frequency of systemic symptoms of steroid depletion, such as fatigue and loss of appetite, was also higher in group 1 (94/120 vs. 42/80, p<0.001). Recent steroid injections and loss of appetite were associated with adrenal insufficiency (p=0.002 and p=0.009, respectively).
Conclusions
The results of this study revealed a high prevalence of adrenal insufficiency in Korean patients hospitalized for TKA due to end-stage osteoarthritis. Recent steroid injections were causally related to the development of adrenal insufficiency. Therefore, adrenal function should be assessed preoperatively to prevent postoperative complications related to adrenal insufficiency.
Key Words: Arthroplasty, Replacement, Knee, Adrenal insufficiency, Prevalence


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