Central Hypoadrenalism

被引:66
作者
Crowley, R. K. [1 ]
Argese, N. [1 ]
Tomlinson, J. W. [1 ]
Stewart, P. M. [2 ]
机构
[1] Univ Birmingham, Ctr Endocrinol Diabet & Metab, Edgbaston B15 2TT, W Midlands, England
[2] Univ Leeds, Sch Med, Leeds LS2 9NL, W Yorkshire, England
基金
英国医学研究理事会;
关键词
PITUITARY-ADRENAL AXIS; GLUCOCORTICOID REPLACEMENT THERAPY; INSULIN-INDUCED HYPOGLYCEMIA; DAILY CORTISOL PRODUCTION; TRAUMATIC BRAIN-INJURY; SHORT SYNACTHEN TEST; LOW-DOSE ACTH; TRANSSPHENOIDAL SURGERY; CUSHINGS-SYNDROME; ANTERIOR-PITUITARY;
D O I
10.1210/jc.2014-2476
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context: Central hypoadrenalism is a frequent complication of pituitary and hypothalamic pathology and is associated with increased morbidity and mortality. Optimal exogenous glucocorticoid use is dependent on the use of appropriate diagnostic tests and careful assessment of the clinical response to glucocorticoid replacement therapy. Evidence Acquisition: A PubMed search for the terms central hypoadrenalism, ACTH deficiency, glucocorticoid suppression, and glucocorticoid replacement was conducted; the papers identified and the references listed were used to build a reference list. Evidence Synthesis: The published literature was assessed to present a summary of the available evidence with regard to etiology, diagnosis, and treatment of central hypoadrenalism. Conclusions: A functional hypothalamic pituitary adrenal axis is essential for normal health and life expectancy; its complexity presents challenges to the clinician in the identification of patients and in the maintenance of such patients in a glucocorticoid-sufficient state. The most common cause of central hypoadrenalism remains exogenous glucocorticoid use. Further research in this field should be directed toward disease prevention by minimizing glucocorticoid exposure and toward the identification of a biomarker for glucocorticoid sufficiency that will aid clinicians in optimizing treatment.
引用
收藏
页码:4027 / 4036
页数:10
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