701 results match your criteria Adrenal Insufficiency and Adrenal Crisis


Low-dose ACTH test for evaluation of hypothalamus-pituitary-adrenal axis preoperatively and 3-month follow-up in non-functioning pituitary adenomas.

J Endocrinol Invest 2020 May 20. Epub 2020 May 20.

Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurugram, Haryana, India.

Background: Peri-operative glucocorticoids are routinely administered to patients undergoing trans-sphenoidal surgery for non-functional pituitary adenomas (NFPA) irrespective of hypothalamus-pituitary-adrenal (HPA) axis status.

Purpose: Evaluation of HPA axis before and 12 weeks after endoscopic trans-sphenoidal adenomectomy (E-TSA) utilizing low-dose (1 μg) ACTH stimulation test (LDACTH) to determine the need for glucocorticoid administration in patients with NFPA. We also determined the factors that can predict occurrence of hypocortisolism at 12 weeks after surgery. Read More

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http://dx.doi.org/10.1007/s40618-020-01292-8DOI Listing

Current management and outcome of pregnancies in women with adrenal insufficiency: experience from a multi-center survey.

J Clin Endocrinol Metab 2020 May 19. Epub 2020 May 19.

Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland.

Context: Appropriate management of adrenal insufficiency (AI) in pregnancy can be challenging due to the rarity of the disease and lack of evidence-based recommendations to guide glucocorticoid- and mineralocorticoid dosage adjustment.

Objective: Multi-center survey on current clinical approaches in managing AI during pregnancy.

Design: Retrospective anonymized data collection from 19 international centers from 2013-2019. Read More

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http://dx.doi.org/10.1210/clinem/dgaa266DOI Listing

Acute illness in patients with concomitant Addison's disease and type 1 diabetes mellitus: Increased incidence of hypoglycaemia and adrenal crises.

Clin Endocrinol (Oxf) 2020 May 12. Epub 2020 May 12.

School of Medicine, The University of Notre Dame, Sydney, Australia.

Background: Patients with Addison's disease (AD) and comorbid type 1 diabetes mellitus (T1DM) are at increased risk of certain acute metabolic disorders relative to patients with one of these conditions only. The reasons for this are unknown.

Methods: All attendances for acute illness by AD patients at the emergency department of a Sydney hospital between 2000 and 2017 were reviewed. Read More

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http://dx.doi.org/10.1111/cen.14219DOI Listing
May 2020
3.457 Impact Factor

[Endocrine Dysfunction Associated with Immune Checkpoint Blockade].

Authors:
Shintaro Iwama

Gan To Kagaku Ryoho 2020 Feb;47(2):203-206

Dept. of Endocrinology and Diabetes, Nagoya University Hospital.

Immune checkpoint inhibitors(ICIs)have been widely used in patients with advanced malignancies. However, these drugs can cause immune-related adverse events(irAEs)in several organs, including lung, skin, gastrointestinal tract, liver, nerve, muscle, and endocrine organs. Endocrine irAEs include hypopituitarism, primary adrenal insufficiency, thyroid dysfunction, hypoparathyroidism, and type 1 diabetes mellitus, which can result in life-threatening consequences, such as adrenal crisis, thyroid storm, severe hypocalcemia, and diabetic ketoacidosis. Read More

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February 2020

Endocrinology in the time of COVID-19: Management of adrenal insufficiency.

Eur J Endocrinol 2020 Apr 1. Epub 2020 Apr 1.

H Simpson, Endocrinology and Metabolic Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland.

We provide guidance on prevention of adrenal crisis during the global COVID-19 crisis, which exposes patients with adrenal insufficiency to an increased risk of acute COVID-19 infection while at the same time restricting access to healthcare due to capacity issues. We highlight the need for education (sick day rules, stringent social distancing rules), equipment (sufficient glucocorticoid supplies, steroid emergency self-injection kit) and empowerment (steroid emergency card, COVID-19 guidelines) to prevent adrenal crises. In patients with adrenal insufficiency developing an acute COVID-19 infection, which frequently presents with continuous high fever, we suggest oral stress dose cover with 20mg hydrocortisone every six hours. Read More

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http://dx.doi.org/10.1530/EJE-20-0361DOI Listing

Significant barriers to diagnosis and management of adrenal insufficiency in Africa.

Endocr Connect 2020 May;9(5):445-456

Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa.

Background: The burden and management of primary adrenal insufficiency (PAI) in Africa have not been well documented. We aimed to identify specific disease characteristics, patient demographics, and patterns of clinical management in established PAI in Africa.

Methods: An online survey of physicians' experience relating to PAI. Read More

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http://dx.doi.org/10.1530/EC-20-0129DOI Listing

A pictorial review of non-traumatic adrenergic crisis.

Emerg Radiol 2020 Apr 16. Epub 2020 Apr 16.

Ohio State University Wexner Medical Center, Columbus, OH, USA.

Non-traumatic adrenal crisis is a rare but critical diagnosis to make in emergency settings due to grave consequences. Various pathologies can present as acute crisis, such as spectrum of endocrine imbalance, ranging from catecholamine excess in pheochromocytomas to acute adrenal insufficiency related to glandular dysfunction. Critical manifestations may be due to structural causes related to adrenal hemorrhage, especially when they are bilateral. Read More

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http://dx.doi.org/10.1007/s10140-020-01777-2DOI Listing

A Rare Presentation of Possible Disseminated Histoplasmosis with Adrenal Insufficiency Leading to Adrenal Crisis in an Immunocompetent Adult: A Case Report.

Case Rep Med 2020 17;2020:8506746. Epub 2020 Mar 17.

Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.

Histoplasmosis is caused by , and commonly it causes an asymptomatic illness. Although is the commonest organism to infect adrenal glands, disseminated histoplasmosis in an immune-competent host leading to adrenal insufficiency is rare in current literature. Here, we report a case of possible disseminated histoplasmosis leading to adrenal crisis in a young Asian immunocompetent male. Read More

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http://dx.doi.org/10.1155/2020/8506746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103037PMC

An analysis of early morning acth levels in the first case of pembrolizumab-induced adrenalitis as a delayed immune-related event (dire) - case study.

Wiad Lek 2020 ;73(2):396-400

Department Of Internal Medicine Ii, Division Of Gastroenterology, Thuringia Clinic "Georgius Agricola", Saalfeld/Saale, Germany.

Objective: The aim: The levels of adrenocorticotrophic hormone (ACTH) are elevated in primary adrenal failure (Addison's disease) with a peak in the early morning hours. This also occurs under hydrocortisone replacement therapy due to the unphysiological substitution regime. The aim was to study ACTH levels under two different replacement regimens. Read More

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Treatment of the adult growth hormone deficiency syndrome with growth hormone: What are the implications for other hormone replacement therapies for hypopituitarism?

Growth Horm IGF Res 2020 Jun 23;52:101316. Epub 2020 Mar 23.

Medical Service, VA Palo Alto Health Care System and Stanford University, Palo Alto, CA 94301, United States of America. Electronic address:

When initiating growth hormone replacement therapy, it is important to consider a patient's other pituitary hormone replacement medications, as adjustments are often necessary. Growth hormone therapy can increase the metabolism of hydrocortisone or endogenous cortisol, unmasking borderline ACTH deficiency and leading to the development of adrenal insufficiency and adrenal crisis. In addition, growth hormone can enhance the metabolism of thyroxine to triiodothyronine, uncovering borderline TSH deficiency. Read More

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http://dx.doi.org/10.1016/j.ghir.2020.101316DOI Listing

Glucocorticoid replacement regimens for treating congenital adrenal hyperplasia.

Cochrane Database Syst Rev 2020 03 19;3:CD012517. Epub 2020 Mar 19.

University of Liverpool, Alder Hey Children's NHS Foundation Trust, Department of Women's and Children's Health, Eaton Road, Liverpool, Merseyside, UK, L12 2AP.

Background: Congenital adrenal hyperplasia (CAH) is an autosomal recessive condition which leads to glucocorticoid deficiency and is the most common cause of adrenal insufficiency in children. In over 90% of cases, 21-hydroxylase enzyme deficiency is found which is caused by mutations in the 21-hydroxylase gene. Managing individuals with CAH due to 21-hydroxylase deficiency involves replacing glucocorticoids with oral glucocorticoids (including prednisolone and hydrocortisone), suppressing adrenocorticotrophic hormones and replacing mineralocorticoids to prevent salt wasting. Read More

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http://dx.doi.org/10.1002/14651858.CD012517.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081382PMC

Prevention of Adrenal Crisis: Cortisol Responses to Major Stress Compared to Stress Dose Hydrocortisone Delivery.

J Clin Endocrinol Metab 2020 Jul;105(7)

Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.

Context: Patients with adrenal insufficiency require increased hydrocortisone cover during major stress to avoid a 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 who are exposed to major stress. Read More

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http://dx.doi.org/10.1210/clinem/dgaa133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241266PMC

The management of glucocorticoid deficiency: Current and future perspectives.

Clin Chim Acta 2020 Jun 5;505:148-159. Epub 2020 Mar 5.

Academic Department of Endocrinology, Beaumont Hospital/RCSI, Dublin, Ireland. Electronic address:

Glucocorticoid deficiency is the clinical state characterised by inadequate cortisol production. It may occur due to the primary failure of the adrenal cortex or to lack of stimulation of the adrenal cortex by adrenocorticotropic hormone. The aim of treatment of glucocorticoid deficiency is to mimic the normal physiological secretion of cortisol, in order to normalise quality of life and reverse pathological sequelae. Read More

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http://dx.doi.org/10.1016/j.cca.2020.03.006DOI Listing

Autoimmune polyglandular syndrome type II with co-manifestation of Addison's and Graves' disease in a 15-year-old boy: case report and literature review.

J Pediatr Endocrinol Metab 2020 Apr;33(4):575-578

Catholic Childrens Hospital Wilhelmstift, Department of Paediatrics, Hamburg, Germany.

Background Autoimmune polyglandular syndrome type II (APS II) is defined as the combination of autoimmune adrenal insufficiency and autoimmune thyroid disease (AITD) and/or type I diabetes mellitus (T1DM) in the same patient. Case presentation A 15-year-old boy had a history of weight loss, nausea and vomiting, headache, restlessness, and tanned skin. He was diagnosed with Graves' disease. Read More

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http://dx.doi.org/10.1515/jpem-2019-0506DOI Listing

Allgrove Syndrome: A Report of New Pathological Variants in the AAAS Gene.

Cornea 2020 Jun;39(6):782-783

Department of Ophthalmology, Centre Hospitalier Universaite Sainte-Justine, Montreal, QC, Canada.

Purpose: To report 2 novel variants in the AAAS gene consistent with the diagnosis of Allgrove syndrome.

Methods: A 12-year-old girl was referred to our clinic for progressive bilateral decrease in visual acuity. She was known for achalasia that had been surgically treated at a very early age. Read More

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http://dx.doi.org/10.1097/ICO.0000000000002287DOI Listing

Impact of glucocorticoid supplementation on reducing perioperative complications in patients on long-term glucocorticoid medication: A propensity score analysis using a nationwide inpatient database.

Am J Surg 2020 Feb 3. Epub 2020 Feb 3.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.

Background: Perioperative glucocorticoid supplementation has been suggested as a potentially effective precaution against perioperative adrenal crisis in patients on long-term glucocorticoid medication.

Methods: This retrospective cohort study used a national inpatient database in Japan. We included patients who underwent general surgery and those who received long-term glucocorticoid medication before surgery. Read More

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http://dx.doi.org/10.1016/j.amjsurg.2020.01.051DOI Listing
February 2020

New Insights and Methods in the Approach to Thalassemia Major: The Lesson From the Case of Adrenal Insufficiency.

Front Mol Biosci 2019 29;6:162. Epub 2020 Jan 29.

Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy.

Thalassemia Major (TM) is a complex pathology that needs a highly skilled approach. Endocrine comorbidities are nowadays the most important complications, including hypogonadism, hypothyroidism, diabetes mellitus, and bone diseases. Recent works stated that there could be a relevant prevalence of adrenal insufficiency (AI) present in TM, and this fact may become crucial, especially in case of major stressful events. Read More

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http://dx.doi.org/10.3389/fmolb.2019.00162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000370PMC
January 2020

Autoimmune Addison's disease.

Best Pract Res Clin Endocrinol Metab 2020 Jan 30:101379. Epub 2020 Jan 30.

Section of Internal Medicine and Endocrine and Metabolic Sciences, Department of Medicine, University of Perugia, Perugia, Italy. Electronic address:

Primary adrenal insufficiency (PAI) occurs in 1/5000-1/7000 individuals in the general population. Autoimmune Addison's disease (AAD) is the major cause of PAI and is a major component of autoimmune polyendocrine syndrome type 1 (APS1) and type 2 (APS2). Presence of 21-hydroxylase autoantibodies (21OHAb) identifies subjects with ongoing clinical or pre-clinical adrenal autoimmunity. Read More

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http://dx.doi.org/10.1016/j.beem.2020.101379DOI Listing
January 2020

Adrenal insufficiency: Physiology, clinical presentation and diagnostic challenges.

Clin Chim Acta 2020 Jun 7;505:78-91. Epub 2020 Feb 7.

Academic Department of Endocrinology, Beaumont Hospital, Dublin 9, Ireland; Royal College of Surgeons in Ireland, 123 St Stephens' Green, Dublin 2, Ireland. Electronic address:

Adrenal insufficiency (AI) is a serious condition, which can arise from pathology affecting the adrenal gland itself (primary adrenal insufficiency, PAI), hypothalamic or pituitary pathology (secondary adrenal insufficiency, SAI), or as a result of suppression of the hypothalamic-pituitaryadrenal (HPA) axis by exogenous glucocorticoid therapy (tertiary adrenal insufficiency, TAI). AI is associated with an increase in morbidity and mortality and a reduction in quality of life. In addition, the most common cause of PAI, autoimmune adrenalitis, may be associated with a variety of other autoimmune disorders. Read More

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http://dx.doi.org/10.1016/j.cca.2020.01.029DOI Listing

Spontaneous fertility and variable spectrum of reproductive phenotype in a family with adult-onset X-linked adrenal insufficiency harboring a novel DAX-1/NR0B1 mutation.

BMC Endocr Disord 2020 Feb 6;20(1):21. Epub 2020 Feb 6.

Department of Medicine, Division of Endocrinology, Escola Paulista de Medicina, Laboratory of Molecular and Translational Endocrinology, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, Sao Paulo, SP, 04039-032, Brazil.

Background: Adrenal hypoplasia congenita (AHC) is an X-linked disorder that affects the adrenal cortex and hypothalamus-pituitary-gonadal axis (HPG), leading to primary adrenocortical insufficiency (PAI) and hypogonadotropic hypogonadism. AHC is caused by a mutation in the DAX-1 gene (NR0B1). More commonly, this disease is characterized by early-onset PAI, with symptoms in the first months of life. Read More

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http://dx.doi.org/10.1186/s12902-020-0500-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006140PMC
February 2020

Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK.

Anaesthesia 2020 Feb 3. Epub 2020 Feb 3.

Department of Intensive Care Medicine, King's College Hospital, Co-Chair, Working Party on behalf of the Association of Anaesthetists, London, UK.

These guidelines aim to ensure that patients with adrenal insufficiency are identified and adequately supplemented with glucocorticoids during the peri-operative period. There are two major categories of adrenal insufficiency. Primary adrenal insufficiency is due to diseases of the adrenal gland (failure of the hormone-producing gland), and secondary adrenal insufficiency is due to deficient adrenocorticotropin hormone secretion by the pituitary gland, or deficient corticotropin-releasing hormone secretion by the hypothalamus (failure of the regulatory centres). Read More

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http://dx.doi.org/10.1111/anae.14963DOI Listing
February 2020

Vomiting and Cardiac Arrest in a 10-Year-Old Girl.

Pediatr Emerg Care 2020 Feb 1. Epub 2020 Feb 1.

From the Department of Pediatrics, McMaster University.

Primary adrenal insufficiency is a potentially life-threatening condition that provides a diagnostic challenge because many patients have months to years of insidious symptomatology. Adrenal crisis is the extreme acute manifestation of primary adrenal insufficiency, presenting with any, or all, of severe weakness, altered mental status, hypotension, and rarely cardiorespiratory arrest. Primary adrenal insufficiency should be considered in patients with clinical features of glucocorticoid and/or mineralocorticoid deficiency. Read More

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http://dx.doi.org/10.1097/PEC.0000000000001957DOI Listing
February 2020

Inclusion of adrenal crisis in the differential diagnosis of distributive shock.

Am J Health Syst Pharm 2020 03;77(6):415-417

Department of Internal Medicine Division of Endocrinology University of Kentucky Albert B. Chandler Hospital Lexington, KY.

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http://dx.doi.org/10.1093/ajhp/zxz324DOI Listing

A Challenging diagnosis that eventually results in a life-threatening condition: Addison's disease and adrenal crisis.

BMJ Case Rep 2019 Dec 29;12(12). Epub 2019 Dec 29.

Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.

A young man endures many years with classic symptoms of Addison's disease due to difficulties in distinguishing this rare condition, whose features are non-specific and insidious in nature. With all facts on hand, the patient's notable history of psychiatric disorders, namely depression, anxiety and social isolation, as well as signs of extreme fatigue and syncope may well have been caused by a gradual onset of primary adrenal insufficiency. Long delays in diagnosis are not uncommon, as in this case where the actual condition was identified just in time when the patient presented with a life-threatening cardiovascular collapse. Read More

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http://dx.doi.org/10.1136/bcr-2019-231858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936478PMC
December 2019

Hypophysitis: An update on the novel forms, diagnosis and management of disorders of pituitary inflammation.

Best Pract Res Clin Endocrinol Metab 2019 12 12;33(6):101371. Epub 2019 Dec 12.

The University of Tennessee Health Science Center, Memphis, TN, 38163, USA; Fox Chase Cancer Center, Philadelphia, PA, USA. Electronic address:

Hypophysitis is a heterogeneous condition that leads to inflammation of the sella and/or suprasellar region, potentially resulting in hormonal deficiencies and/or mass effects. A preponderance of hypophysitis subtypes have an underlying autoimmune aetiology. The overall incidence and prevalence of hypophysitis has dramatically increased over the past decade, mainly due to increased awareness of the condition in the medical community, improvements in imaging techniques, and a rise in the occurrence of certain forms of hypophysitis such as IgG4 hypophysitis (IgG4Hy) and immune checkpoint inhibitor induced hypophysitis (ICIHy). Read More

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http://dx.doi.org/10.1016/j.beem.2019.101371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7078033PMC
December 2019

Management of Hypopituitarism.

J Clin Med 2019 Dec 5;8(12). Epub 2019 Dec 5.

Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, OX3 7LE, Oxford, UK.

Hypopituitarism includes all clinical conditions that result in partial or complete failure of the anterior and posterior lobe of the pituitary gland's ability to secrete hormones. The aim of management is usually to replace the target-hormone of hypothalamo-pituitary-endocrine gland axis with the exceptions of secondary hypogonadism when fertility is required, and growth hormone deficiency (GHD), and to safely minimise both symptoms and clinical signs. Adrenocorticotropic hormone deficiency replacement is best performed with the immediate-release oral glucocorticoid hydrocortisone (HC) in 2-3 divided doses. Read More

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http://dx.doi.org/10.3390/jcm8122153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947162PMC
December 2019

Detecting adrenal insufficiency in patients with immunoglobulin A nephropathy, lupus nephritis, and transplant recipients qualified for glucocorticoid withdrawal.

Pol Arch Intern Med 2019 12 6;129(12):874-882. Epub 2019 Dec 6.

Department of Internal Diseases and Endocrinology, Medical University of Warsaw, Warsaw, Poland.

Introduction: Long‑term glucocorticoid (GC) therapy is the most common cause of secondary adrenal insufficiency (AI), which undiagnosed may lead to life‑threatening adrenal crisis.

Objectives: The aim of the study was to evaluate AI in patients treated long‑term with GCs, receiving a low maintenance dose (≤5 mg of prednisone or equivalent), namely, its prevalence and persistence, risk factors, and diagnostic accuracy of morning cortisol and dehydroepiandrosterone sulfate (DHEA‑S) levels.

Patients And Methods: Adrenal function was evaluated in 40 patients before and after GC withdrawal and at least 1 year later. Read More

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http://dx.doi.org/10.20452/pamw.15091DOI Listing
December 2019

A retrospective analysis of adrenal crisis in steroid-dependent patients: causes, frequency and outcomes.

BMC Endocr Disord 2019 Dec 2;19(1):129. Epub 2019 Dec 2.

Institut für Politikwissenschaft und Soziologie, Julius-Maximilians-Universität Würzburg, Wittelsbacherplatz 1, 97074, Würzburg, Germany.

Background: Adrenal patients have a lifelong dependency on steroid replacement therapy and are vulnerable to sudden death from undertreated adrenal crisis. Urgent treatment with parenteral steroids is needed, often with IV saline for volume repletion. Episodes of adrenal crisis are, for most patients, relatively infrequent and they may not be well prepared to respond. Read More

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http://dx.doi.org/10.1186/s12902-019-0459-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6889201PMC
December 2019

Adrenoleukodystrophy in the era of newborn screening.

Curr Opin Endocrinol Diabetes Obes 2020 Feb;27(1):47-55

Division of Pediatric Endocrinology & Diabetes, Children's Hospital at Montefiore, Albert Einstein School of Medicine, Bronx, New York, USA.

Purpose Of Review: Adrenoleukodystrophy (ALD) is a peroxisomal disorder with varying clinical presentations, including adrenal insufficiency, neurologic disease, and testicular dysfunction. The present review is intended to describe the current knowledge of the pathophysiology of ALD and provide an update regarding newborn screening, diagnosis, monitoring, and treatment.

Recent Findings: New York State initiated newborn screening for ALD on December 30, 2013. Read More

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http://dx.doi.org/10.1097/MED.0000000000000515DOI Listing
February 2020

Fatal adrenal crisis due to Addison's disease arising in the context of autoimmune polyglandular syndrome type 1.

Forensic Sci Med Pathol 2020 Mar 28;16(1):166-170. Epub 2019 Nov 28.

Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53792, USA.

The autoimmune polyglandular syndromes (APS) are rare immune-mediated endocrinopathies causing destruction of multiple endocrine and non-endocrine organs. Involvement of adrenal glands associated with any type of APS results in Addison's disease. While patients with Addison's disease often suffer from symptoms of neuroglycopenia, lethal hypotension and hypoglycemia are uncommon. Read More

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http://dx.doi.org/10.1007/s12024-019-00204-4DOI Listing

Adrenal Crisis. Reply.

N Engl J Med 2019 11;381(22):2182-2183

Karolinska Institutet, Stockholm, Sweden

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http://dx.doi.org/10.1056/NEJMc1913160DOI Listing
November 2019
55.873 Impact Factor

Adrenal Crisis.

N Engl J Med 2019 11;381(22):2181-2182

Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain

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http://dx.doi.org/10.1056/NEJMc1913160DOI Listing
November 2019

Adrenal Crisis.

N Engl J Med 2019 11;381(22):2181

University of Michigan, Ann Arbor, MI

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http://dx.doi.org/10.1056/NEJMc1913160DOI Listing
November 2019

Adrenal Crisis.

Authors:
Aaron Spital

N Engl J Med 2019 11;381(22):2181

Mt. Sinai St. Luke's Hospital, New York, NY

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http://dx.doi.org/10.1056/NEJMc1913160DOI Listing
November 2019

Prehospital Management of Acute Addison Disease: Audit of Patients Attending a Referral Hospital in a Regional Area.

J Endocr Soc 2019 Dec 17;3(12):2194-2203. Epub 2019 Sep 17.

School of Medicine, Sydney, The University of Notre Dame, Darlinghurst, Australia.

Context: Adrenal crisis (AC) causes morbidity and mortality in patients with Addison disease [primary adrenal insufficiency (PAI)]. Patient-initiated stress dosing (oral or parenteral hydrocortisone) is recommended to avert ACs. Although these should be effective, the continued incidence of ACs remains largely unexplained. Read More

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http://dx.doi.org/10.1210/js.2019-00263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839527PMC
December 2019
3 Reads

Stress-Dosed Glucocorticoids and Mineralocorticoids Before Intensive Endurance Exercise in Primary Adrenal Insufficiency.

Clin J Sport Med 2019 11;29(6):e73-e75

Endocrinology and Metabolism, Wake Forest University, Winston-Salem, NC.

Patients with primary adrenal insufficiency (PAI) require increased doses of glucocorticoids and mineralocorticoids during stressors, such as surgery, trauma, and sepsis. Although current guidelines exist for dose adjustments in these situations, there is no accepted dosing regimen for patients with PAI participating in intensive endurance exercise. Given the extensive physiologic stress of events, such as marathons, triathlons, and similar events, it is likely that a "stress-dose" of adrenal replacement therapy will not only prevent adrenal crisis, but also improve performance. Read More

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http://dx.doi.org/10.1097/JSM.0000000000000540DOI Listing
November 2019
1 Read

Adrenal insufficiency in kidney transplant patients during low-dose prednisolone therapy: a cross-sectional case-control study.

Nephrol Dial Transplant 2019 Sep 20. Epub 2019 Sep 20.

Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Background: Maintenance immunosuppressive regimens after renal transplantation (RTx) most often include prednisolone, which may induce secondary adrenal insufficiency, a potentially life-threatening side effect to glucocorticoid (GC) treatment due to the risk of acute adrenal crisis. We investigated the prevalence of prednisolone-induced adrenal insufficiency in RTx patients receiving long-term low-dose prednisolone treatment.

Methods: We performed a case-control study of patients on renal replacement therapy differing in terms of GC exposure. Read More

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http://dx.doi.org/10.1093/ndt/gfz180DOI Listing
September 2019
1 Read

Initiation of levothyroxine in a patient with hypothyroidism inducing adrenal crisis requiring VA ECMO: a tale of preventable disaster.

BMJ Case Rep 2019 Aug 30;12(8). Epub 2019 Aug 30.

Pulmonary Medicine and Critical Care, UCSF, Fresno, California, USA.

A 31-year-old man with a recent diagnosis of hypothyroidism presented to the emergency department as a transfer from the clinic for severe hypotension and hypoglycaemia. The patient endorsed a 2-week history of severe fatigue, weight loss, nausea and non-bloody emesis. He was aggressively hydrated and vasopressors were initiated. Read More

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http://dx.doi.org/10.1136/bcr-2019-230601DOI Listing
August 2019
3 Reads

Progression of Hypopituitarism and Hypothyroidism after Treatment with Pembrolizumab in a Patient with Adrenal Metastasis from Non-small-cell Lung Cancer.

Intern Med 2019 Dec 28;58(24):3557-3562. Epub 2019 Aug 28.

Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Japan.

Pembrolizumab, or anti-programmed death receptor 1 antibody, is an immune checkpoint inhibitor that can cause immune-related adverse events. We herein report for the first time the progression of hypopituitarism and hypothyroidism after treatment with pembrolizumab in a patient with adrenal metastasis of non-small-cell lung cancer. Severe primary hypothyroidism occurred three weeks after the first administration of pembrolizumab. Read More

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http://dx.doi.org/10.2169/internalmedicine.3008-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949454PMC
December 2019
15 Reads

Adrenal Crisis.

N Engl J Med 2019 08;381(9):852-861

From the School of Medicine, Sydney (R.L.R.), the University of Notre Dame Australia, Darlinghurst, NSW (R.L.R.), the Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide, North Terrace, Adelaide, SA (D.J.T.), and the Menzies School of Health Research and Royal Darwin Hospital, Tiwi, NT (H.F.) - all in Australia; and the Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, and the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (H.F.).

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http://dx.doi.org/10.1056/NEJMra1807486DOI Listing
August 2019
17 Reads
55.873 Impact Factor

[Opioid-induced adrenal insufficiency: Case report and synthesis of the literature].

Rev Med Interne 2019 Nov 20;40(11):758-763. Epub 2019 Aug 20.

Service de médecine interne, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.

Introduction: Opioid therapy for pain relief is associated with several adverse effects. Herein, we report the potential consequences of opioid use on the adrenal function.

Observation: A 49-year-old woman with sickle cell anemia (Hemoglobin SS) was admitted for the treatment of a vaso-occlusive crisis. Read More

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http://dx.doi.org/10.1016/j.revmed.2019.07.003DOI Listing
November 2019
6 Reads

Type II polyglandular autoimmune syndrome: a case of Addison's disease precipitated by use of levothyroxine.

BMJ Case Rep 2019 Aug 21;12(8). Epub 2019 Aug 21.

Endocrinology, Covenant Clinic, Waterloo, Iowa, USA.

A 46-year-old woman was referred to the endocrinology clinic for evaluation of progressive fatigue, dizziness and treatment-resistant hypothyroidism. Initial laboratory results revealed hypothyroidism, hyponatraemia and hyperkalaemia. Liothyronine sodium (Cytomel) was initiated, which exacerbated her fatigue and dizziness. Read More

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http://dx.doi.org/10.1136/bcr-2019-230760DOI Listing
August 2019
3 Reads

[Controlling glucocorticoid treatment in critically ill patients with rheumatism exemplified by systemic lupus erythematosus].

Z Rheumatol 2019 Dec;78(10):947-954

Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.

Background: Infections are one of the most common clinical problems in patients with rheumatic diseases who need to be treated with glucocorticoids in an intensive care unit. To date, there are no recommendations for the standardized control of glucocorticoid treatment in such situations.

Objective: Based on a literature search this paper provides an overview of evidence-based and eminence-based recommendations for the control of glucocorticoid treatment under intensive care conditions using the example of systemic lupus erythematosus. Read More

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http://dx.doi.org/10.1007/s00393-019-00686-1DOI Listing
December 2019
4 Reads

Fluorescence techniques in adrenal surgery.

Gland Surg 2019 Jul;8(Suppl 1):S22-S27

Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA.

This chapter describes the use of fluorescence via indocyanine green (ICG) in minimally invasive adrenal surgery (laparoscopic and robotic). ICG is a non-toxic dye that can aid identification of vascular structures and parenchymal tissue planes in real time. The primary utility of ICG fluorescence in adrenal surgery is to help delineate the margins of resection, to guide a more precise operation. Read More

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http://dx.doi.org/10.21037/gs.2019.03.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646814PMC
July 2019
3 Reads

Comparison of Pheochromocytoma-Specific Morbidity and Mortality Among Adults With Bilateral Pheochromocytomas Undergoing Total Adrenalectomy vs Cortical-Sparing Adrenalectomy.

JAMA Netw Open 2019 08 2;2(8):e198898. Epub 2019 Aug 2.

Genomic Medicine Institute, Lerner Research Institute and Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.

Importance: Large studies investigating long-term outcomes of patients with bilateral pheochromocytomas treated with either total or cortical-sparing adrenalectomies are needed to inform clinical management.

Objective: To determine the association of total vs cortical-sparing adrenalectomy with pheochromocytoma-specific mortality, the burden of primary adrenal insufficiency after bilateral adrenalectomy, and the risk of pheochromocytoma recurrence.

Design, Setting, And Participants: This cohort study used data from a multicenter consortium-based registry for 625 patients treated for bilateral pheochromocytomas between 1950 and 2018. Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2019.8898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692838PMC
August 2019
15 Reads

Congenital Adrenal Hyperplasia Presenting as Pulseless Ventricular Tachycardia in a Neonate.

Cureus 2019 May 24;11(5):e4749. Epub 2019 May 24.

Internal Medicine, Dow University of Health Sciences, Karachi, PAK.

Congenital adrenal hyperplasia (CAH) comprises a group of autosomal recessive inherited disorders that arise due to defects in one of the enzymes of steroidogenesis pathway in the adrenal glands. Ninety-five percent of the cases occur due to deficiency in 21-hydroxylase (21-OH). Clinically, CAH due to 21-OH deficiency presents in two distinct forms, classic CAH and non-classic CAH. Read More

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http://dx.doi.org/10.7759/cureus.4749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663285PMC
May 2019
5 Reads

Adrenal Insufficiency: A Forgotten Diagnosis in HIV/AIDS Patients in Developing Countries.

Int J Endocrinol 2019 23;2019:2342857. Epub 2019 Jun 23.

Department of Internal Medicine, Mbeya Zonal Referral Hospital, Mbeya, Tanzania.

Adrenal insufficiency (AI) is one of the most common endocrine disease in patients with HIV/AIDS, leading to high morbidity and mortality in HIV patients who become critically ill. Various etiologies are associated with the condition, including cytomegalovirus (CMV), , lymphoma, Kaposi's sarcoma, and drugs such as rifampin, among others. HIV patients with advanced disease develop relative cortisol deficiency largely due to the reduction of cortisol reserve, which predisposes patients to adrenal crisis in periods of stress or critical illness. Read More

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http://dx.doi.org/10.1155/2019/2342857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612386PMC
June 2019
7 Reads

Epidemiology, pathogenesis, and diagnosis of Addison's disease in adults.

J Endocrinol Invest 2019 Dec 18;42(12):1407-1433. Epub 2019 Jul 18.

FIRS Laboratories, Llanishen, Cardiff, UK.

Background: Addison's disease (AD) is a rare disorder and among adult population in developed countries is most commonly caused by autoimmunity. In contrast, in children genetic causes are responsible for AD in the majority of patients.

Purpose: This review describes epidemiology, pathogenesis, genetics, natural history, clinical manifestations, immunological markers and diagnostic strategies in patients with AD. Read More

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http://dx.doi.org/10.1007/s40618-019-01079-6DOI Listing
December 2019
3 Reads

Perioperative "stress dose" of corticosteroid: Pharmacological and clinical perspective.

J Anaesthesiol Clin Pharmacol 2019 Apr-Jun;35(2):147-152

Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, New Delhi, India.

Various exogenous steroid preparations have been in use for a wide range of indications. We, as an anesthesiologist often encounters a surgical patient receiving chronic steroid therapy. Perioperative use of steroid is associated with major complications such as full-blown adrenal crisis in the perioperative period due to the secondary adrenal insufficiency. Read More

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http://dx.doi.org/10.4103/joacp.JOACP_242_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598572PMC
July 2019
8 Reads