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Adrenal emergency steroid card. Permission to reprint granted by the Addisons Disease Self-Help Group, addisonsdisease.org.uk
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Adrenal crisis is an acute life-threatening emergency contributing to the excess mortality that is reported in patients with adrenal insufficiency. The incidence of adrenal crisis is estimated to be 8 per 100 patient years in patients with adrenal insufficiency. Patients with adrenal crisis present systemically unwell with nonspecific signs and sym...
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Background
Coronavirus disease 2019 is an emerging respiratory disease caused by a novel coronavirus effect on 10-20% of total healthcare workers and was first detected in December 2019 in Wuhan, China. This study was designed to assess effect of COVID-19 stressors on healthcare workers’ performance and attitude. A descriptive cross sectional resea...
Citations
... Другие ведущие триггеры у детей и подростков могут включать в себя травмы головного мозга, различные хирургические вмешательства, проведение анестезиологического пособия, усиленную физическую нагрузку и эмоциональный стресс [17,19,24]. Согласно некоторым источникам, неудовлетворительное соблюдение режима заместительной терапии ГК со стороны родителей пациентов младшего возраста или детей старшего возраста может спровоцировать ОНН [19,22]. ...
... Патофизиология ОНН Согласно современным научным данным, патофизиология формирования ОНН до конца еще не изучена [5,24]. Точно известно, что при ОНН у детей и подростков возникает несоответствие между потребностью и доступностью кортизола [8,17,24,35]. ...
... Патофизиология ОНН Согласно современным научным данным, патофизиология формирования ОНН до конца еще не изучена [5,24]. Точно известно, что при ОНН у детей и подростков возникает несоответствие между потребностью и доступностью кортизола [8,17,24,35]. Физиологические последствия острого дефицита последнего огромны и сопровождаются широким спектром симптомов, возникающих уже после нескольких часов депривации кортизола из-за короткого периода полураспада уровня этого гормона, составляющего всего 90 минут [14]. Известные биологические эффекты кортизола обусловливают то, что у взрослых пациентов с НН это ургентное состояние обычно развивается в течение нескольких часов, а у детей еще быстрее (менее 1 часа) [16]. ...
Introduction . Acute adrenal insufficiency (AAI) is a severe endocrinopathy whose victims include children and adolescents and which can be life-threatening despite its low incidence. Analysis of issues associated with intensive care of children with this pathology is of vital interest for pediatric anesthesiology and critical care medicine. The aim of this work was to assess current views on the etiopathogenesis, clinical pathology and intensive treatment of pediatric AAI. Materials and methods . The topic was researched by analyzing publications found in the Cochrane Library, PubMed and Medscape using the following search terms: “acute adrenal insufficiency, children and adolescents, intensive therapy, fluid management”, with 65 published sources chosen. Results and discussion . In AAI, caused by a sharp deficiency of cortisol (and mineralocorticoids), which triggers an inflammatory reaction, electrolyte imbalance and hemodynamic disorders. AAI presents with dehydration, nausea and vomiting, feelings of pain, hypotension, tachycardia, seizures and impaired consciousness up to coma. Laboratory tests in children often reveal hyperkalemia, hyponatremia, hypoglycemia and hypercalcemia. Intensive management of AAI in the ICU relies on parenteral corticosteroids (preferably intravenous hydrocortisone). Two or three days later, when the child is stable, they are switched to oral hormones. Meanwhile, fluid management is performed over 2 to 3 days to increase the circulating blood volume and relieve dehydration with crystalloid fluids. Conclusion . A clearer understanding of the etiopathogenesis, clinical manifestations and diagnostic features of AAI, along with knowledge of emergency care algorithms, will improve the quality of intensive therapy of pediatric patients with this condition.
... frequency of adrenal crisis is roughly 8.3 cases per 100 patient years, with dental procedures accounting for approximately 4.6 to 9% of these events. (5) Around 0.7% of the population are prescribed extended courses of glucocorticoids for various medical conditions like pemphigus, myasthenia gravis, lymphomas, leukemias, dermatitis, rheumatoid arthritis, and inflammatory bowel disease, among others.(6) However, long-term use, estimated at 1% to 3% globally, can lead to an increase in the mean body weight in the range of 4-8%.(1) ...
Adrenal insufficiency (AI) is linked to a rare medical emergency, acute AI, or adrenal crisis (AC), which can occur following stressful events, like infection or surgery. A commonly overlooked form of secondary AI occurs when individuals take exogenous glucocorticoids for extended periods of time, resulting in hypoactivity of the adrenal glands. Many patients take glucocorticoids to treat conditions like asthma, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, or dermatitis. These patients may be prone to secondary AI, which may go undetected, increasing their risk of facing a medical emergency. Our aim is to review the literature on current guidelines for corticosteroid supplementation for patients at risk of AC; and assess the risk of developing AI in patients taking exogenous glucocorticoids and whether the current supplementation guidelines require modifications. Current recommendations from the Addison’s disease self-help group and Miller suggest steroid supplementation for dental procedures only for patients with primary AI. However, they do not recommend supplementation for patients with secondary or tertiary adrenal insufficiency. The drawbacks of short-term supplementation of glucocorticoids in patients at risk of secondary AI, for stressful dental procedures is negligible. Adverse effects of glucocorticoid use are typically seen after prolonged usage. Thus, steroid supplementation before dental procedures should be considered, customized based on identified risk factors and the stress associated with the procedure, as a pragmatic and preemptive approach to reduce the risk of AC. Moreover, this review highlights the need for updated guidance on supplementing patients at risk of secondary AI
... It should be emphasized that in patients with multiple pituitary deficiencies, hormone replacement therapy for hypocortisolism must be given first to avoid a hypoadrenalism crisis [26]. Replacement of other pituitary axes, especially the thyroid axis, may slatentize a misdiagnosed hypoadrenalism. ...
Secondary adrenal insufficiency (SAI) is an endocrine disorder due to impaired secretion of ACTH resulting from any disease affecting the pituitary gland. Glucocorticoid replacement therapy is mandatory to ensure patient survival, haemodynamic stability, and quality of life. In fact, a correct dose adjustement is mandatory due to the fact that inappropriately low doses expose patients to hypoadrenal crisis, while inappropriately high doses contribute to glucose metabolic and cardiovascular deterioration. This review analyses the current evidence from available publications on the epidemiology and aetiology of SAI and examines the association between glucocorticoid replacement therapy and glucometabolic and cardiovascular effects.
... Conversely, secondary adrenal cortex insufficiency, more prevalent, stems mainly from pituitary damage affecting adrenocortical hormone secretion (Grossman, 2010;Hahner et al., 2021). AI frequently progresses to adrenal crisis, significantly heightening patient mortality rates (Dineen et al., 2019). Prolonged elevation of endogenous cortisol levels can result in Cushing's syndrome, leading to numerous organ complications such as hypertension, obesity, dysregulation of glucose and lipid metabolism, and cognitive impairment (Pivonello et al., 2016). ...
Background
Some observational studies and clinical experiments suggest a close association between gut microbiota and metabolic diseases. However, the causal effects of gut microbiota on adrenal diseases, including Adrenocortical insufficiency, Cushing syndrome, and Hyperaldosteronism, remain unclear.
Methods
This study conducted a two-sample Mendelian randomization analysis using summary statistics data of gut microbiota from a large-scale genome-wide association study conducted by the MiBioGen Consortium. Summary statistics data for the three adrenal diseases were obtained from the FinnGen study. The study employed Inverse variance weighting, MR-Egger, and MR-PRESSO methods to assess the causal relationship between gut microbiota and these three adrenal diseases. Additionally, a reverse Mendelian randomization analysis was performed for bacteria found to have a causal relationship with these three adrenal diseases in the forward Mendelian randomization analysis. Cochran’s Q statistic was used to test for heterogeneity of instrumental variables.
Results
The IVW test results demonstrate that class Deltaproteobacteria, Family Desulfovibrionaceae, and Order Desulfovibrionales exhibit protective effects against adrenocortical insufficiency. Conversely, Family Porphyromonadaceae, Genus Lachnoclostridium, and Order MollicutesRF9 are associated with an increased risk of adrenocortical insufficiency. Additionally, Family Acidaminococcaceae confers a certain level of protection against Cushing syndrome. In contrast, Class Methanobacteria, Family Lactobacillaceae, Family Methanobacteriaceae, Genus. Lactobacillus and Order Methanobacteriales are protective against Hyperaldosteronism. Conversely, Genus Parasutterella, Genus Peptococcus, and Genus Veillonella are identified as risk factors for Hyperaldosteronism.
Conclusions
This two-sample Mendelian randomization analysis revealed a causal relationship between microbial taxa such as Deltaproteobacteria and Desulfovibrionaceae and Adrenocortical insufficiency, Cushing syndrome, and Hyperaldosteronism. These findings offer new avenues for comprehending the development of adrenal diseases mediated by gut microbiota.
... Of note, adrenal crisis has been exceptionally reported in patients who were offered zoledronic acid, while being prior known with a chronic adrenal failure [48][49][50]. In 2022-2023, a similar unusual case was reported upon first infusion on a 70-year-old female who was previously diagnosed with Addison's disease [51]. ...
Zoledronate (or zoledronic acid) represents a standard (guideline-based) approach in the area of anti-resorptive medication (namely, an annual 15-minute perfusion of 5 mg for os-teoporosis treatment), while the same drug (with doses/regimes variations) is used for other bone metabolic conditions such as Paget’s disease of the bone or skeleton metastasis originating from different cancers. The objective of this narrative review was to highlight the most recent published data with respect to zoledronic acid use as part of the complex clinical management amid primary osteoporosis in addition to other osteo-metabolic clin-ical entities. This was a research based on exploring PubMed database with respect to the search words “zoledronic acid” and “primary osteoporosis”. We included highly relevant (from the clinical perspective), English-published, full-length articles that have been re-cently published (between January 2023 and March 2024). From 249 results, 31 articles met the inclusion timeline criteria across the 15-month analysis and the final results were based on data provided from 16 articles. Important insights concern not only the zoledronic acid administration, the efficacy and the safety profile, but, also, an extension on daily indications with concern to diabetic bone disease, liver osteodystrophy, osteogen-esis imperfecta or Paget’s disease of the bone. Keywords: osteoporosis, rehabilitation, zoledronic acid, DXA, hypercalcemia, bone, surgery, prosthesis, Paget’s disease of the bone, liver osteodystrophy
... Although postoperative fever after major surgical procedures is a relatively common event that occurs in between 10 and 40% of patients [6], limited information is currently available on the incidence of fever after adrenal surgery. The overall incidence of complications associated with laparoscopic adrenalectomy was previously reported to be 9.5% (range 2. [9][10][11][12][13][14][15][16][17][18][19][20], with the most common postoperative complication being bleeding (21.5% of all cases), followed by wound complications (13%). The exact incidence of postoperative fever has not yet been reported, while other complications, including fever, occur at an incidence of approximately 9.5% and include thromboembolism, neurological abnormalities, anemia, neutropenia, nausea, headache, shoulder tip pain, and subcutaneous and mediastinal emphysema [2]. ...
... Only 8% of patients with Cushing syndrome developed postoperative fever in the present study. Although complex local variations in cortisol levels and the mechanisms of homeostasis in the body have not yet been fully elucidated, they are considered to have important functions in the hypothalamus and pituitary gland, such as the control of inflammation and maintenance of body temperature [10]. ...
Background
Laparoscopic adrenalectomy is widely performed for a number of hormone-producing tumors and postoperative management depends on the hormones produced. In the present study, we conducted a retrospective analysis to clarify the risk factors for postoperative complications, particularly postoperative fever after laparoscopic adrenalectomy.
Methods
We analyzed 406 patients who underwent laparoscopic adrenalectomy at our hospital between 2003 and 2019. Postoperative fever was defined as a fever of 38 °C or higher within 72 h after surgery. We investigated the risk factors for postoperative fever after laparoscopic adrenalectomy.
Results
There were 188 males (46%) and 218 females (54%) with a median age of 52 years. Among these patients, tumor pathologies included 188 primary aldosteronism (46%), 75 Cushing syndrome (18%), and 80 pheochromocytoma (20%). Postoperative fever developed in 124 of all patients (31%), 30% of those with primary aldosteronism, 53% of those with pheochromocytoma, and 8% of those with Cushing syndrome. A multivariate logistic regression analysis identified pheochromocytoma and non-Cushing syndrome as independent predictors of postoperative fever. Postoperative fever was observed in 42 out of 80 cases of pheochromocytoma (53%), which was significantly higher than in cases of non-pheochromocytoma (82/326, 25%, p < 0.01). In contrast, postoperative fever developed in 6 out of 75 cases of Cushing syndrome (8%), which was significantly lower than in cases of non-Cushing syndrome (118/331, 35.6%, p < 0.01).
Conclusion
Since postoperative fever after laparoscopic adrenalectomy is markedly affected by the hormone produced by pheochromocytoma and Cushing syndrome, it is important to carefully consider the need for treatment.
... The most common method for measuring cortisol is through blood tests. A high or low cortisol level indicates an adrenal gland problem (Dineen, et al., 2019). ...
The use of stress training induction is very important for psychology and neuroscience studies. It allows the researcher to manipulate the emotional activation of subjects to determine its effect on their behavior. This study was performed to explore the link between stress and heart rate variability (HRV) measures. HRV in the field of the nonlinear domain is also useful in determining the autonomic balance and is a more reliable marker of mortality and problems in patients with cardiovascular diseases. These protocols let researchers examine the physiological paths of a stress reaction in physical condition and infection, which is crucial to stress research. This study aimed to support reliable information about psychological stress protocols and HRV measures during nonlinear measures. To conduct a systematic review of the evidence, a meta-analysis of the proof was carried out according to the inclusion criteria, performing a comprehensive search of electronic sources and a linear review of references. Once conference papers were removed, journal papers illustrating well-made studies analyzing HRV with healthy subjects were considered for inclusion if the stress-inducing protocols were the same. A total of 147 volunteers were enrolled in the four studies, which investigated 11 non-linear HRV measures. Mental Arithmetic Task is primarily used as a stress-inducing test, and three studies extracted SD1, SD2, and SD1/SD2 for HRV non-linear measurements. This study shows that induction of mental stress can ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 23 (1): gmr19038 E.T. Attar 2 increase the levels of cortisol in healthy subjects. In conclusion, the results showed that investigating nonlinear HRV measures for the duration of mental stress is still needed. Furthermore, the nonlinear HRV measures can be spread over to other fields where HRV has been shown to be clinically meaningful.
... Similarly, adrenal adverse events following COVID-19 vaccination have been reported. These events are rare but may lead to adrenal crisis (AC), which is a life-threatening condition [113,114]. A caseseries report of 5 patients with known adrenal insufficiency (AI), 3 with primary and 2 with secondary AI, who develop AC within the first 24 h after administration of the first dose of the Astra-Zeneca ChAdOx1 SARS-CoV-2 vaccine was published [115]. ...
The emergence of the COVID-19 pandemic has led to the rapid and worldwide devel-opment and investigation of multiple vaccines. While most side effects of these vaccines are mild and transient, potentially severe adverse events may occur and involve the endocrine system. This narrative review aims to explore the current knowledge on potential endocrine adverse effects following COVID-19 vaccination, with thyroid disorders being the most common. Data about pi-tuitary, adrenal, diabetes, and gonadal events will also be reviewed. This review also provides a comprehensive understanding of the pathogenesis of endocrine disorders associated with SARS-CoV-2 vaccines. A PubMed/MEDLINE, Embase database (Elsevier), and Google Scholar research were performed. Case reports case series, original studies, and reviews written in English and published online up to 31 August 2023 were selected and reviewed. Data on endocrine adverse events of SARS-CoV-2 vaccines is accumulating. However, their causal relationship with COVID-19 vaccines is not strong enough to make a definite conclusion, and further studies are needed to clarify the pathogenesis mechanisms of endocrine disorders linked to COVID-19 vac-cines.
... Each patient must be aware of the signs indicating an impending crisis and the need to increase the replacement dose of glucocorticoids in stressful situations [25]. The annual incidence of adrenal crisis ranges is 5.2-8.3% in patients with adrenocortical insufficiency, and, if untreated, will result in death [26]. ...
Patient: Female, 42-year-old
Final Diagnosis: Adrenal myelolipoma • congenital adrenal hyperplasia
Symptoms: Abdominal pain • fatigue • nausea
Clinical Procedure: —
Specialty: Endocrinology and Metabolic
Objective
Rare disease
Background
21-hydroxylase deficiency, an essential enzyme for glucocorticoid and mineralocorticoid synthesis, is the cause of congenital adrenal hyperplasia (CAH) in more than 95% of cases. It is an autosomal recessive disorder encoded by the CYP21A2 gene, categorized into classical forms, which encompass the salt-wasting (SW) and simple virilizing (SV) forms, as well as the nonclassical form (NC). The aim of medical treatment is to replace missing glucocorticoids and, if necessary, mineralocorticoids, while also reducing elevated adrenal androgens.
Case Report
We present the case of a 42-year-old woman with CAH who discontinued therapy during adolescence and was admitted to hospital with fatigue, nausea, and severe abdominal pain. A CT scan showed an extreme enlargement of the adrenal glands. Laboratory tests revealed elevated levels of 17-hydroxyprogesterone and other adrenal androgens, along with normal plasma metanephrine levels. Decreased morning cortisol levels suggested partial adrenal insufficiency requiring glucocorticoid replacement therapy. Due to the development of several serious complications and clinical deterioration, the multidisciplinary team recommended bilateral removal of masses measuring 300×250×200 mm on the right side and 250×200×200 mm on the left side. Histological and immunochemical examination confirmed the presence of giant myelolipomas with adrenal cortex hyperplasia.
Conclusions
Adrenal tumors, particularly myelolipomas, have a higher prevalence in patients with CAH. Our case report provides further evidence of the suspected link between non-compliant CAH therapy and the development of myelolipomas, along with promotion of their pronounced growth.
... AI has an insidious onset and presents with nonspecific and subtle clinical features that overlap with those of TB or HIV, delaying early diagnosis and prompt initiation of optimal therapy. Because of this, the condition is often referred to as one of the great mimickers of medicine [2,[63][64][65][66]. Such nonspecific signs and symptoms include weight loss, arthralgia, myalgia, abdominal pain, and hypotension, as reported by most clinical studies [16-18, 30, 67]. ...
... Hypoglycemia and hyperkalemia, as reported by Sharma et al [38], in addition to euvolemic hyponatremia, are relatively common metabolic disorders in patients with AI. Reduced hepatic glucose release and gluconeogenesis explain the observed hypoglycemia, while mineralocorticoid deficiency is associated with increased water and sodium loss with potassium retention resulting in hyponatremia and hyperkalemia [63][64][65][66]. In addition to the metabolic disorders commonly encountered in patients with AI, glucocorticoid deficiency is often associated with immunologic and cellular dysfunction. ...
... It often occurs in the sun-exposed areas of the face, neck, and arms or in areas that are subjected to repeated mechanical shear stress, such as the elbows, knees, palmar creases, and buccal mucosa [2,63,65,66]. The loss of the negative feedback by cortisol in patients with AI results in an increased release of pro-opiomelanocortin and proopiomelanocortin-derived peptides, such as ACTH and α melanocyte-stimulating hormone, which bind to the melanocortin 1 receptor and cause increased melanogenesis, hence the observed hyperpigmentation [64,65]. ...
Background
Despite the high frequency of adrenal insufficiency in patients with tuberculosis or HIV, its diagnosis is often missed or delayed resulting in increased mortality. This systematic review and meta-analysis aimed to document the prevalence, significant clinical features, and predictors of adrenal insufficiency in adult patients with tuberculosis or HIV.
Methods
We systematically searched Medline, EMBASE, CINAHL, Cochrane Library, and Africa Journal Online databases for published studies on adrenal insufficiency in adult patients with tuberculosis or HIV. The pooled prevalence of adrenal insufficiency was determined using random-effect model meta-analysis. A narrative review was used to describe the significant clinical features and predictors of adrenal insufficiency in adult patients with tuberculosis or HIV.
Results
A total of 46 studies involving 4,044 adult participants (1,599 participants with tuberculosis and 2,445 participants with HIV) were included. The pooled prevalence of adrenal insufficiency in participants with tuberculosis was 33% (95% CI 22-45, I2 = 97.7%, p<0.001) and 28% (95% CI 18-38, I2 = 98.9%, p<0.001) in those with HIV. Presentation with multi-drug resistant tuberculosis, abdominal pain, salt craving, myalgia, increased severity and duration of tuberculosis disease, and the absence of nausea predicted adrenal insufficiency in participants with tuberculosis in four studies. Cytomegalovirus antigenemia positivity, rifampicin therapy, and eosinophilia of >3% were reported to predict adrenal insufficiency in participants with HIV in two studies.
Conclusions
Adrenal insufficiency is relatively common in adults with tuberculosis or HIV. Its timely screening, diagnosis, and management in patients with these two conditions should be encouraged to avert mortality.