Adrenal insufficiency

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13 papers 100 to 500 followers
By Ehud Ur Professor and Head, Endocrinology, UBC, Vancouver
Alessandro Prete, Angela E Taylor, Irina Bancos, David J Smith, Mark A Foster, Sibylle Kohler, Violet Fazal-Sanderson, John Komninos, Donna M O'Neil, Dimitra A Vassiliadi, Christopher J Mowatt, Radu Mihai, Joanne L Fallowfield, Djillali Annane, Janet M Lord, Brian G Keevil, John A H Wass, Niki Karavitaki, Wiebke Arlt
CONTEXT: Patients with adrenal insufficiency require increased hydrocortisone cover during major stress to avoid life-threatening adrenal crisis. However, current treatment recommendations are not evidence-based. OBJECTIVE: To identify the most appropriate mode of hydrocortisone delivery in patients with adrenal insufficiency exposed to major stress. DESIGN AND PARTICIPANTS: Cross-sectional study: 122 unstressed healthy subjects and 288 subjects exposed to different stressors (major trauma [N=83], sepsis [N=100], and combat stress [N=105])...
March 14, 2020: Journal of Clinical Endocrinology and Metabolism
Stafford L Lightman, Matthew T Birnie, Becky L Conway-Campbell
The past decade has seen several critical advances in our understanding of hypothalamic-pituitary-adrenal (HPA) axis regulation. Homeostatic physiological circuits need to integrate multiple internal and external stimuli and provide a dynamic output appropriate for the response parameters of their target tissues. The HPA axis is an example of such a homeostatic system. Recent studies have shown that circadian rhythmicity of the major output of this system-the adrenal glucocorticoid hormones corticosterone in rodent and predominately cortisol in man-comprises varying amplitude pulses that exist due to a subhypothalamic pulse generator...
June 1, 2020: Endocrine Reviews
Nydia Burgos, Hans K Ghayee, Naykky Singh-Ospina
PURPOSE OF REVIEW: Adrenal insufficiency is a rare disease characterized by cortisol deficiency. The evaluation of patients suspected of having adrenal insufficiency can be challenging because of the rarity of the disease and limitations in the biochemical assessment of the cortisol status by either basal or dynamic testing [adrenocorticotropic hormone (ACTH) stimulation test]. Prompt and adequate diagnosis is of paramount importance to avoid adverse outcomes. We aimed to summarize the recent developments in the conduction and interpretation of the ACTH stimulation test for the diagnosis of adrenal insufficiency...
June 2019: Current Opinion in Endocrinology, Diabetes, and Obesity
Gudmundur Johannsson
No abstract text is available yet for this article.
June 2016: Endocrine
Felix G Riepe
Congenital adrenal hyperplasia is one of the most prevalent genetic endocrine diseases. A new guideline from the endocrine society offers expert opinion and evidence-based recommendations on the diagnosis and management of this challenging condition.
January 2011: Nature Reviews. Endocrinology
Stefan R Bornstein, Bruno Allolio, Wiebke Arlt, Andreas Barthel, Andrew Don-Wauchope, Gary D Hammer, Eystein S Husebye, Deborah P Merke, M Hassan Murad, Constantine A Stratakis, David J Torpy
OBJECTIVE: This clinical practice guideline addresses the diagnosis and treatment of primary adrenal insufficiency. PARTICIPANTS: The Task Force included a chair, selected by The Clinical Guidelines Subcommittee of the Endocrine Society, eight additional clinicians experienced with the disease, a methodologist, and a medical writer. The co-sponsoring associations (European Society of Endocrinology and the American Association for Clinical Chemistry) had participating members...
February 2016: Journal of Clinical Endocrinology and Metabolism
Naykky Singh Ospina, Alaa Al Nofal, Irina Bancos, Asma Javed, Khalid Benkhadra, Ekta Kapoor, Aida N Lteif, Neena Natt, M Hassan Murad
CONTEXT: The diagnosis of adrenal insufficiency is clinically challenging and often requires ACTH stimulation tests. OBJECTIVE: To determine the diagnostic accuracy of the high- (250 mcg) and low- (1 mcg) dose ACTH stimulation tests in the diagnosis of adrenal insufficiency. METHODS: We searched six databases through February 2014. Pairs of independent reviewers selected studies and appraised the risk of bias. Diagnostic association measures were pooled across studies using a bivariate model...
February 2016: Journal of Clinical Endocrinology and Metabolism
Leonie H A Broersen, Alberto M Pereira, Jens Otto L Jørgensen, Olaf M Dekkers
OBJECTIVE: We aimed to estimate pooled percentages of patients with adrenal insufficiency after treatment with corticosteroids for various conditions in a meta-analysis. Secondly, we aimed to stratify the results by route of administration, disease, treatment dose, and duration. METHODS: We searched seven electronic databases (PubMed, MEDLINE, EMBASE, COCHRANE, CENTRAL, Web of Science, and CINAHL/Academic Search Premier) in February 2014 to identify potentially relevant studies...
June 2015: Journal of Clinical Endocrinology and Metabolism
Warrick J Inder, Caroline Meyer, Penny J Hunt
Addison's disease may be complicated by hypertension and less commonly by heart failure. We review the pathophysiology of the renin-angiotensin-aldosterone axis in Addison's disease and how this is altered in the setting of hypertension and heart failure. An essential first step in management in both conditions is optimizing glucocorticoid replacement and considering dose reduction if excessive. Following this, if a patient with Addison's disease remains hypertensive, the fludrocortisone dose should be reviewed and reduced if there are clinical and/or biochemical signs of mineralocorticoid excess...
June 2015: Clinical Endocrinology
Nicolas Kluger, Niina Matikainen, Harri Sintonen, Annamari Ranki, Risto P Roine, Camilla Schalin-Jäntti
OBJECTIVE: Patients with Addison's disease (AD) on conventional replacement therapy have impaired health-related quality of life (HRQoL). It is possible that lower hydrocortisone (HC) doses recommended by current guidelines could restore HRQoL. We compared HRQoL in AD patients treated according to current HC recommendations to that of the age- and gender-standardized general population. SUBJECTS, DESIGN AND MEASUREMENT: We assessed HRQoL in a cross-sectional setting with the 15D instrument in a Finnish AD cohort (n = 107) and compared the results with those of a large sample of general population (n = 5671)...
October 2014: Clinical Endocrinology
Marianne Oksnes, Sigridur Björnsdottir, Magnus Isaksson, Paal Methlie, Siri Carlsen, Roy M Nilsen, Jan-Erik Broman, Kai Triebner, Olle Kämpe, Anna-Lena Hulting, Sophie Bensing, Eystein S Husebye, Kristian Løvås
CONTEXT: Conventional glucocorticoid replacement therapy fails to mimic the physiological cortisol rhythm, which may have implications for morbidity and mortality in patients with Addison's disease. OBJECTIVE: The objective of the study was to compare the effects of continuous sc hydrocortisone infusion (CSHI) with conventional oral hydrocortisone (OHC) replacement therapy. DESIGN, PATIENTS, AND INTERVENTIONS: This was a prospective crossover, randomized, multicenter clinical trial comparing 3 months of treatment with thrice-daily OHC vs CSHI...
May 2014: Journal of Clinical Endocrinology and Metabolism
Catherine Napier, Simon H S Pearce
PURPOSE OF REVIEW: The purpose of this article is to review the current therapy of Addison's disease and to highlight recent developments in this field. RECENT FINDINGS: Conventional steroid replacement for Addison's disease consists of twice or three-times daily oral hydrocortisone and once-daily fludrocortisone; however, new treatment modalities such as modified-released hydrocortisone and continuous subcutaneous hydrocortisone infusion have recently been developed...
June 2014: Current Opinion in Endocrinology, Diabetes, and Obesity
Evangelia Charmandari, Nicolas C Nicolaides, George P Chrousos
Adrenal insufficiency is the clinical manifestation of deficient production or action of glucocorticoids, with or without deficiency also in mineralocorticoids and adrenal androgens. It is a life-threatening disorder that can result from primary adrenal failure or secondary adrenal disease due to impairment of the hypothalamic-pituitary axis. Prompt diagnosis and management are essential. The clinical manifestations of primary adrenal insufficiency result from deficiency of all adrenocortical hormones, but they can also include signs of other concurrent autoimmune conditions...
June 21, 2014: Lancet
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