Diagnosis and management of adrenal insufficiency

Abstract:

Adrenal insufficiency refers to inadequate production of cortisol to meet the demands of a major physiologic stress. Adrenal insufficiency can be primary, due to intrinsic adrenal disease, or central, as a component of hypopituitarism with adrenocorticotropin deficiency. Basal hormone testing establishes the diagnosis and distinguishes primary from central disease for the majority of cases, and dynamic testing is reserved when basal testing results are equivocal. The management of acute adrenal crisis focuses on volume repletion, sustained glucocorticoid exposure, and identification of a precipitating cause. Chronic therapy attempts to approximate physiologic replacement of glucocorticoid and, for primary adrenal insufficiency, also mineralocorticoid. Overtreatment can cause iatrogenic Cushing syndrome, and undertreatment during intercurrent illness can be life-threatening. Sick day rules, education, and medical alert identification are essential to avoid catastrophic adrenal crises, but fatal events occur even in educated patients despite taking the best precautions. In this article, we emphasize the approach to the patient to establish or to exclude the diagnosis and principles of acute and chronic therapy.

Año de publicación:

2018

Keywords:

• mineralocorticoid
• Hypopituitarism
• hyponatremia
• aldosterone
• Glucocorticoid
• cortisol
• Adrenal crisis
• Hyperkalemia
• Addison’s disease

Fuente:

scopus