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Adrenal suppression

Последний просмотренный: 30 May 2025
Last updated: 02 May 2025

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • presence of risk factors
  • sudden cessation or rapid tapering of glucocorticoids
  • acute circulatory collapse with hypotension and tachycardia
Полная информация

Другие диагностические факторы

  • lassitude and generalized constitutional symptoms
  • history of weight gain and increased appetite
  • history of depression, agitation, or sleep disorders
  • cushingoid exam features
  • history of difficult-to-control diabetes or hypertension
  • absence of hyperpigmentation or autoimmune stigmata
  • medroxyprogesterone use
  • history of treatment for endogenous Cushing syndrome
Полная информация

Факторы риска

  • 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
  • nonphysiologic scheduling of glucocorticoid dose
  • medroxyprogesterone use
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • serum comprehensive chemistry panel
  • serum a.m. cortisol
  • adrenocorticotropic hormone (ACTH) stimulation test
  • CBC
  • thyroid function tests
Полная информация

Исследования, проведение которых нужно рассмотреть

  • insulin tolerance test (ITT)
  • overnight metyrapone test
  • urine synthetic glucocorticoids
Полная информация

Неотложные исследования

  • home waking salivary cortisone

Алгоритм лечения

Начальные

features of adrenal crisis

Острый

minor intercurrent stress

severe intercurrent stress

ПРОДОЛЖЕНИЕ

stable patients taking corticosteroids for underlying disease: suitable for discontinuation or taper

Составители

Авторы

Suzanne L. Quinn Martinez, MD
Suzanne L. Quinn Martinez

Staff Endocrinologist

HCA Florida Orange Park

Program Director, Internal Medicine

Orange Park

FL

Раскрытие информации

SLQM declares that she has no competing interests.

Выражение благодарностей

Dr Suzanne L. Quinn Martinez would like to gratefully acknowledge Dr M. Cecilia Lansang, a previous contributor to this topic.

Раскрытие информации

MCL is a consultant for the Sanofi group of companies and is an author of several references cited in this topic.

Рецензенты

Tiffany M Cortes, MD

Assistant Professor of Medicine

Division of Endocrinology

UT Health Science Center San Antonio

San Antonio

TX

Раскрытие информации

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.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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, tumor, head trauma, and surgery (non-Cushing)
    • Corticosteroid withdrawal syndrome
    Больше Отличия
  • Рекомендации

    • European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency
    • Adrenal suppression from exogenous glucocorticoids: recognizing risk factors and preventing morbidity
    Больше Рекомендации
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