Ahmet Uçar1, Firdevs Baş2, Nurçin Saka2. 1. Growth-Development and Pediatric Endocrine Unit, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey. aucar76@yahoo.com. 2. Growth-Development and Pediatric Endocrine Unit, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Abstract
BACKGROUND: Adrenal insufficiency (AI) is a wellknown cause of potentially life-threatening disorders. Defects at each level of the hypothalamic-pituitary-adrenal axis can impair adrenal function, leading to varying degrees of glucocorticoid (GC) deficiency. Iatrogenic AI induced by exogenous GCs is the most common cause of AI. The criteria for the diagnosis and management of iatrogenic AI, neonatal AI, and critical illness-related corticosteroid insufficiency (CIRCI) are not clear. DATA SOURCES: We reviewed the recent original publications and classical data from the literature, as well as the clinical, diagnostic and management strategies of pediatric AI. RESULTS: Practical points in the diagnosis and management of AI with an emphasis on iatrogenic AI, neonatal AI, and CIRCI are provided. Given the lack of sensitive and practical biochemical tests for diagnosis of subtle AI, GC treatment has to be tailored to highly suggestive clinical symptoms and signs. Treatment of adrenal crisis is well standardized and patients almost invariably respond well to therapy. It is mainly the delay in treatment that is responsible for mortality in adrenal crisis. CONCLUSIONS: Education of patients and health care professionals is mandatory for timely interventions for patients with adrenal crisis.
BACKGROUND:Adrenal insufficiency (AI) is a wellknown cause of potentially life-threatening disorders. Defects at each level of the hypothalamic-pituitary-adrenal axis can impair adrenal function, leading to varying degrees of glucocorticoid (GC) deficiency. Iatrogenic AI induced by exogenous GCs is the most common cause of AI. The criteria for the diagnosis and management of iatrogenic AI, neonatal AI, and critical illness-related corticosteroid insufficiency (CIRCI) are not clear. DATA SOURCES: We reviewed the recent original publications and classical data from the literature, as well as the clinical, diagnostic and management strategies of pediatric AI. RESULTS: Practical points in the diagnosis and management of AI with an emphasis on iatrogenic AI, neonatal AI, and CIRCI are provided. Given the lack of sensitive and practical biochemical tests for diagnosis of subtle AI, GC treatment has to be tailored to highly suggestive clinical symptoms and signs. Treatment of adrenal crisis is well standardized and patients almost invariably respond well to therapy. It is mainly the delay in treatment that is responsible for mortality in adrenal crisis. CONCLUSIONS: Education of patients and health care professionals is mandatory for timely interventions for patients with adrenal crisis.
Authors: Eirini Meimaridou; Claire R Hughes; Julia Kowalczyk; Leonardo Guasti; J Paul Chapple; Peter J King; Li F Chan; Adrian J L Clark; Louise A Metherell Journal: Mol Cell Endocrinol Date: 2012-12-29 Impact factor: 4.102
Authors: Montserrat Lara-Velazquez; Alexander Perdomo-Pantoja; Patrick R Blackburn; Jennifer M Gass; Thomas R Caulfield; Paldeep S Atwal Journal: Mol Genet Genomic Med Date: 2017-07-20 Impact factor: 2.183
Authors: Despoina Tzira; Anargyroula Prezerakou; Ioannis Papadatos; Artemis Vintila; Anastasia Bartzeliotou; Filia Apostolakou; Ioannis Papassotiriou; Vassiliki Papaevangelou Journal: SAGE Open Med Date: 2018-09-25
Authors: Stefan Pilz; Michael Krebs; Walter Bonfig; Wolfgang Högler; Anna Hochgerner; Greisa Vila; Christian Trummer; Verena Theiler-Schwetz; Barbara Obermayer-Pietsch; Peter Wolf; Thomas Scherer; Florian Kiefer; Elke Fröhlich-Reiterer; Elena Gottardi-Butturini; Klaus Kapelari; Stefan Schatzl; Susanne Kaser; Günter Höfle; Dietmar Schiller; Vinzenz Stepan; Anton Luger; Stefan Riedl Journal: J Klin Endokrinol Stoffwechs Date: 2022-03-02