Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presence of risk factors
- sudden cessation or rapid tapering of glucocorticoids
- acute circulatory collapse with hypotension and tachycardia
Outros fatores diagnósticos
- lassitude and generalised constitutional symptoms
- history of weight gain and increased appetite
- history of depression, agitation, or sleep disorders
- cushingoid examination features
- history of difficult-to-control diabetes or hypertension
- absence of hyperpigmentation or autoimmune stigmata
- medroxyprogesterone use
- history of treatment for endogenous Cushing's syndrome
Fatores de risco
- systemic glucocorticoid administration
- high potency or dose of exogenous glucocorticoids
- prolonged glucocorticoid treatment (e.g., >3 weeks)
- local glucocorticoid administration
- megestrol use
- intermittent high-dose exogenous glucocorticoid
- non-physiological scheduling of glucocorticoid dose
- medroxyprogesterone use
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- serum comprehensive chemistry panel
- serum a.m. cortisol
- adrenocorticotropic hormone (ACTH) stimulation test
- FBC
- thyroid function tests
Investigações a serem consideradas
- insulin tolerance test (ITT)
- overnight metyrapone test
- urine synthetic glucocorticoids
Novos exames
- home waking salivary cortisone
Algoritmo de tratamento
features of adrenal crisis
minor intercurrent stress
severe intercurrent stress
stable patients taking corticosteroids for underlying disease: suitable for discontinuation or taper
Colaboradores
Autores
Suzanne L. Quinn Martinez, MD
Staff Endocrinologist
HCA Florida Orange Park
Program Director, Internal Medicine
Orange Park
FL
Declarações
SLQM declares that she has no competing interests.
Agradecimentos
Dr Suzanne L. Quinn Martinez would like to gratefully acknowledge Dr M. Cecilia Lansang, a previous contributor to this topic.
Declarações
MCL is a consultant for the Sanofi group of companies and is an author of several references cited in this topic.
Revisores
Tiffany M Cortes, MD
Assistant Professor of Medicine
Division of Endocrinology
UT Health Science Center San Antonio
San Antonio
TX
Disclosures
TMC declares that she has no competing interests.
Antoine Tabarin, MD
Head
Department of Endocrinology
University Hospital of Bordeaux
Pessac
France
Раскрытие информации
AT declares that he has no competing interests.
Maralyn Druce, MA, MBBS, MRCP, PhD
Clinical Lecturer
Honorary Consultant
Department of Endocrinology
Barts and The London School of Medicine and Dentistry
St Bartholomew's Hospital
London
UK
Раскрытие информации
MD declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Prete A, Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ. 2021 Jul 12;374:n1380.Полный текст Аннотация
Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013 Aug 15;9(1):30.Полный текст Аннотация
Beuschlein F, Else T, Bancos I, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. J Clin Endocrinol Metab. 2024 Jun 17;109(7):1657-83.Полный текст Аннотация
Arlt W; Society for Endocrinology Clinical Committee. Society for Endocrinology endocrine emergency guidance: emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients. Endocr Connect. 2016 Sep;5(5):G1-3.Полный текст Аннотация
Woodcock T, Barker P, Daniel S, et al. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. Anaesthesia. 2020 May;75(5):654-63.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Primary adrenal insufficiency
- Pituitary compression, tumour, head trauma, and surgery (non-Cushing's)
- Corticosteroid withdrawal syndrome
Больше ОтличияРекомендации
- European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency
- Adrenal insufficiency and adrenal crisis-who is at risk and how should they be managed safely
Больше Рекомендации
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