The Approach to the Adult with Newly Diagnosed Adrenal Insufficiency
The Approach to the Adult with Newly Diagnosed Adrenal Insufficiency
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DOI：
10.1210/jc.2009-0032
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发表时间：
2009-04-01
影响因子：
5.8
通讯作者：
Arlt, Wiebke
中科院分区：
文献类型：
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作者：
Arlt, Wiebke
肾上腺功能不全，主要表现为肾上腺危象，是一种危及生命的紧急情况，需要及时的治疗管理，包括液体复苏和应激剂量氢化可的松的管理。原发性肾上腺功能不全最常由自身免疫性肾上腺素引起，下丘脑-垂体瘤是继发性肾上腺功能不全最常见的原因。然而，确切的潜在诊断需要通过逐步诊断方法来确认，同时要注意其他鉴别诊断的可能性。糖皮质激素的长期替代治疗，以及原发性肾上腺皮质功能不全患者的盐皮质激素替代治疗需要仔细监测。然而，目前的替代策略仍然需要优化，最近的研究表明，原发性和继发性肾上腺功能不全患者的主观健康状况显着受损，死亡率增加。未来的研究将探索脱氢表雄酮替代和修饰的延迟释放氢化可的松的潜力，以改善肾上腺功能不全患者的前景。（临床内分泌代谢杂志94：1059-1067，2009）
Adrenal insufficiency, primarily presenting as an adrenal crisis, is a life-threatening emergency and requires prompt therapeutic management including fluid resuscitation and stress dose hydrocortisone administration. Primary adrenal insufficiency is most frequently caused by autoimmune adrenalitis, and hypothalamic-pituitary tumors represent the most frequent cause of secondary adrenal insufficiency. However, the exact underlying diagnosis needs to be confirmed by a stepwise diagnostic approach, with an open eye for other differential diagnostic possibilities. Chronic replacement therapy with glucocorticoids and, in primary adrenal insufficiency, mineralocorticoids requires careful monitoring. However, current replacement strategies still require optimization as evidenced by recent studies demonstrating significantly impaired subjective health status and increased mortality in patients with primary and secondary adrenal insufficiency. Future studies will have to explore the potential of dehydroepiandrosterone replacement and modified delayed-release hydrocortisone to improve the prospects of patients with adrenal insufficiency. (J Clin Endocrinol Metab 94: 1059-1067, 2009)