Adrenal Insufficiency
Hahner, Stefanie Ross, Richard J Arlt, Wiebke Bancos, Irina Burger-Stritt, Stephanie Torpy, David J Husebye, Eystein S Quinkler, Marcus
Hahner, Stefanie
Ross, Richard J
Arlt, Wiebke
Bancos, Irina
Burger-Stritt, Stephanie
Torpy, David J
Husebye, Eystein S
Quinkler, Marcus
Abstract
Adrenal insufficiency (AI) is a condition characterized by an absolute or relative deficiency of adrenal cortisol production. Primary AI (PAI) is rare and is caused by direct adrenal failure. Secondary AI (SAI) is more frequent and is caused by diseases affecting the pituitary, whereas in tertiary AI (TAI), the hypothalamus is affected. The most prevalent form is TAI owing to exogenous glucocorticoid use. Symptoms of AI are non-specific, often overlooked or misdiagnosed, and are related to the lack of cortisol, adrenal androgen precursors and aldosterone (especially in PAI). Diagnosis is based on measurement of the adrenal corticosteroid hormones, their regulatory peptide hormones and stimulation tests. The goal of therapy is to establish a hormone replacement regimen that closely mimics the physiological diurnal cortisol secretion pattern, tailored to the patient's daily needs. This Primer provides insights into the epidemiology, mechanisms and management of AI during pregnancy as well as challenges of long-term management. In addition, the importance of identifying life-threatening adrenal emergencies (acute AI and adrenal crisis) is highlighted and strategies for prevention, which include patient education, glucocorticoid emergency cards and injection kits, are described.
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Date
2021-03-11
Type
Article
Subject
Oncology, Diet & nutrition, Biochemistry
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Citation
Hahner S, Ross RJ, Arlt W, Bancos I, Burger-Stritt S, Torpy DJ, Husebye ES, Quinkler M. Adrenal insufficiency. Nat Rev Dis Primers. 2021 Mar 11;7(1):19. doi: 10.1038/s41572-021-00252-7
Journal / Source Title
Nature Reviews. Disease Primers
DOI
10.1038/s41572-021-00252-7
PMID
33707469
Publisher
Nature Publishing Group
Publisher’s URL
http://www.nature.com/nrdp