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Adrenal suppression

Última revisão: 22 Sep 2025
Última atualização: 02 May 2025

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
Detalhes completos

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
Detalhes completos

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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • serum comprehensive chemistry panel
  • serum a.m. cortisol
  • adrenocorticotropic hormone (ACTH) stimulation test
  • FBC
  • thyroid function tests
Detalhes completos

Investigações a serem consideradas

  • insulin tolerance test (ITT)
  • overnight metyrapone test
  • urine synthetic glucocorticoids
Detalhes completos

Novos exames

  • home waking salivary cortisone

Algoritmo de tratamento

Inicial

features of adrenal crisis

AGUDA

minor intercurrent stress

severe intercurrent stress

CONTÍNUA

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

Colaboradores

Autores

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

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

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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

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