Adrenal Insufficiency - Aetiology, Diagnosis and Treatment.
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Date
2015-01
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Abstract
Adrenal insufficiency is caused by either primary adrenal failure or by
hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first
codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal
nature. Though, it is a rare disease but is life threatening when overlooked. Main
presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus
diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls
remain. The diagnosis is adequately established by the 250 μg ACTH
(adrenocorticotropic hormone) stimulation test in most cases. Glucocorticoids provide
life saving treatment but long-term quality of life is impaired, perhaps because therapy
is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has
been introduced that could help to restore quality of life. It may be useful in pubertal
girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack
of objective methods of assessment and is therefore largely based on clinical grounds.
Thus, long-term management of patients with adrenal insufficiency remains a challenge,
requiring an experienced specialist Search strategy
We searched Medline and PubMed for reviews and original articles related to adrenal
insufficiency.
Keywords used included adrenal insufficiency and incidence, prevalence, cause, origin,
diagnosis, function test, imaging, hydrocortisone, glucocorticoid, mineralocorticoid,
dehydroepiandrosterone, management, treatment, therapy, replacement, crisis, quality
of life, well-being, pregnancy, prognosis, morbidity and mortality.
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Keywords
Adrenal insufficiency, glucocorticoid
Citation
Akter Nazma, Qureshi Nazmul Kabir. Adrenal Insufficiency - Aetiology, Diagnosis and Treatment. Delta Medical College Journal. 2015 Jan; 3(1): 36-47.