尽管已知内源性糖皮质激素对于应激条件下的生存至关重要，并且下丘脑-垂体-肾上腺 (HPA) 轴的激活可驱动足够的反应，但有关急性疾病患者肾上腺形态的数据很少。本研究的目的是评估急性疾病患者与非急性疾病患者的肾上腺形态。这项横断面研究包括： 402 名因疑似 SARS-CoV-2 感染而被送往急诊科 (ED) 的患者（3 月 - 2020 年 5 月）[主要队列]； 200名因急性病症入住急诊室的患者（2018年12月至2019年2月）[对照组A]； 200 名接受非急性病症放射学评估的门诊患者（2019 年 1 月至 2 月）[对照组 B]。检查胸部和/或腹部 CT 扫描以识别肾上腺结节或增生。在主要队列中，24.9% 的患者发现肾上腺形态改变（15.4% 肾上腺增生；9.5% 肾上腺结节）。与对照组 B（8.5%；分别为 p = 0.02 和 p = 0.03）相比，主要队列 (15.4%) 和对照组 A (15.5%) 的肾上腺增生频率均较高。在主要队列中，14.9%的患者在30天内死亡。根据多变量分析，肾上腺增生是死亡的独立危险因素（p = 0.04），年龄较大（p <0.001）和活动性癌症（p = 0.01）也是如此。急性疾病患者中肾上腺增生的显着频率表明 HPA 轴由于压力条件而过度激活。肾上腺增生患者短期死亡风险增加表明，这可能是预后较差的一个标志。版权所有 © 2024。由 Elsevier Inc. 出版。

Few data are available on adrenal morphology in patients with acute diseases, although it is known that endogenous glucocorticoids are essential for survival under stress conditions and that an adequate response is driven by activation of the hypothalamic-pituitary-adrenal (HPA) axis.The aim of this study was to assess adrenal morphology in patients with acute disease compared with patients with non-acute disease.This cross-sectional study included: 402 patients admitted to the emergency department (ED) for suspected SARS-CoV-2 infection (March-May, 2020) [main cohort]; 200 patients admitted to the ED for acute conditions (December 2018-February 2019) [control group A]; 200 outpatients who underwent radiological evaluation of non-acute conditions (January-February 2019) [control group B]. Chest and/or abdominal CT scans were reviewed to identify adrenal nodules or hyperplasia.In the main cohort, altered adrenal morphology was found in 24.9% of the patients (15.4% adrenal hyperplasia; 9.5% adrenal nodules). The frequency of adrenal hyperplasia was higher both in the main cohort (15.4%) and control group A (15.5%) compared to control group B (8.5%; p = 0.02 and p = 0.03, respectively). In the main cohort, 14.9% patients died within 30 d. According to a multivariate analysis, adrenal hyperplasia was an independent risk factor for mortality (p = 0.04), as were older age (p <0.001) and active cancer (p = 0.01).The notable frequency of adrenal hyperplasia in patients with acute diseases suggests an exaggerated activation of the HPA axis due to stressful conditions. The increased risk of short-term mortality found in patients with adrenal hyperplasia suggests that it may be a possible hallmark of worse prognosis.Copyright © 2024. Published by Elsevier Inc.