Adrenal suppression
Summary
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presence of risk factors
- sudden cessation or rapid tapering of glucocorticoids
- acute circulatory collapse with hypotension and tachycardia
Otros factores de diagnóstico
- 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
Factores de riesgo
- 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
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- serum comprehensive chemistry panel
- serum a.m. cortisol
- adrenocorticotropic hormone (ACTH) stimulation test
- CBC
- thyroid function tests
Pruebas diagnósticas que deben considerarse
- insulin tolerance test (ITT)
- overnight metyrapone test
- urine synthetic glucocorticoids
Pruebas emergentes
- home waking salivary cortisone
Algoritmo de tratamiento
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
Divulgaciones
SLQM declares that she has no competing interests.
Agradecimientos
Dr Suzanne L. Quinn Martinez would like to gratefully acknowledge Dr M. Cecilia Lansang, a previous contributor to this topic.
Divulgaciones
MCL is a consultant for the Sanofi group of companies and is an author of several references cited in this topic.
Revisores por pares
Tiffany M Cortes, MD
Assistant Professor of Medicine
Division of Endocrinology
UT Health Science Center San Antonio
San Antonio
TX
Divulgaciones
TMC declares that she has no competing interests.
Antoine Tabarin, MD
Head
Department of Endocrinology
University Hospital of Bordeaux
Pessac
France
Divulgaciones
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
Divulgaciones
MD declares that she has no competing interests.
Agradecimiento de los revisores por pares
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Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Prete A, Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ. 2021 Jul 12;374:n1380.Texto completo Resumen
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.Texto completo Resumen
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.Texto completo Resumen
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.Texto completo Resumen
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.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Primary adrenal insufficiency
- Pituitary compression, tumor, head trauma, and surgery (non-Cushing)
- Corticosteroid withdrawal syndrome
Más DiferencialesGuías de práctica clínica
- 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
Más Guías de práctica clínica
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