Abstract:
BACKGROUND:Conventional glucocorticoid (GC) replacement for patients with adrenal insufficiency (AI) is inadequate. Patients with AI continue to have increased mortality and morbidity and compromised quality of life despite treatment and monitoring. OBJECTIVES:i) To review current management of AI and the unmet medical need based on literature and treatment experience and ii) to offer practical advice for managing AI in specific clinical situations. METHODS:The review considers the most urgent questions endocrinologists face in managing AI and presents generalised patient cases with suggested strategies for treatment. RESULTS:Optimisation and individualisation of GC replacement remain a challenge because available therapies do not mimic physiological cortisol patterns. While increased mortality and morbidity appear related to inadequate GC replacement, there are no objective measures to guide dose selection and optimisation. Physicians must rely on experience to recognise the clinical signs, which are not unique to AI, of inadequate treatment. The increased demand for corticosteroids during periods of stress can result in a life-threatening adrenal crisis (AC) in a patient with AI. Education is paramount for patients and their caregivers to anticipate, recognise and provide proper early treatment to prevent or reduce the occurrence of ACs. CONCLUSIONS:This review highlights and offers suggestions to address the challenges endocrinologists encounter in treating patients with AI. New preparations are being developed to better mimic normal physiological cortisol levels with convenient, once-daily dosing which may improve treatment outcomes.
journal_name
Eur J Endocrinoljournal_title
European journal of endocrinologyauthors
Grossman A,Johannsson G,Quinkler M,Zelissen Pdoi
10.1530/EJE-13-0450subject
Has Abstractpub_date
2013-10-21 00:00:00pages
R165-75issue
6eissn
0804-4643issn
1479-683Xpii
EJE-13-0450journal_volume
169pub_type
杂志文章,评审abstract:OBJECTIVE:Cushing's disease (CD) is usually caused by ACTH-secreting pituitary microadenomas, while silent corticotroph adenomas (SCA) are macroadenomas without Cushingoid features. However, the molecular mechanism(s) underlying their different tumor growth remains unknown. The aim of the current study was to evaluate ...
journal_title:European journal of endocrinology
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journal_title:European journal of endocrinology
pub_type: 临床试验,杂志文章,多中心研究
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journal_title:European journal of endocrinology
pub_type: 杂志文章,随机对照试验
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更新日期:2009-12-01 00:00:00
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journal_title:European journal of endocrinology
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journal_title:European journal of endocrinology
pub_type: 杂志文章
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更新日期:2002-09-01 00:00:00
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journal_title:European journal of endocrinology
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更新日期:2011-12-01 00:00:00
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pub_type: 杂志文章
doi:10.1530/eje.0.1330591
更新日期:1995-11-01 00:00:00
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更新日期:2009-09-01 00:00:00
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pub_type: 杂志文章
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更新日期:2015-04-01 00:00:00
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更新日期:2000-03-01 00:00:00
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更新日期:2012-02-01 00:00:00
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更新日期:2003-04-01 00:00:00
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更新日期:2007-11-01 00:00:00
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更新日期:1996-05-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2002-01-01 00:00:00
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更新日期:2005-07-01 00:00:00
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更新日期:2001-11-01 00:00:00