Adrenal insufficiency

Husebye, Eystein S.; Pearce, Simon H. S.; Krone, Nils; Kämpe, Olle

doi:10.1016/s0140-6736(21)00136-7

Cited by 165 publications

(173 citation statements)

References 133 publications

Supporting

Mentioning

159

Contrasting

Unclassified

Order By: Relevance

“…In clinical practice the use of hydrocortisone or prednisolone are often preferable due to their more predictable pharmacokinetics compared to their precursor hormones cortisone and prednisone [9]. The normal functioning adrenal glands are thought to produce 5-10 mg cortisol per m 2 body surface area/per day; this equates to an oral hydrocortisone dose of 15-25 mg/per day for an adult [11]. Due to its short half-life hydrocortisone is usually given in 2-3 divided doses with the largest dose in the morning and the last dose at least 4-6 hours prior to bedtime to avoid sleep disturbances.…”

Section: Glucocorticoid Replacementmentioning

confidence: 99%

“…The Endocrine Society 2016 guidance on management of primary adrenal insufficiency suggests a starting dose of fludrocortisone 50-100mcg in those with confirmed deficiency (assessed by way of plasma renin and aldosterone levels) [4]. Typically higher doses of replacement therapy are required for the more physically active and less sedentary patient cohorts [11].…”

Section: Mineralocorticoid Replacementmentioning

confidence: 99%

“…It is advised against routine hormonal monitoring, instead for titration of treatment based on clinical response. In cases where malabsorption is suspected further analysis with serum or salivary cortisol day curves are recommended as a guide for dosing [4] but there is a lack of reliable biomarkers for treatment monitoring and notably measured concentrations of ACTH are not a useful parameter [11,17].…”

Section: Glucocorticoids (Dose Titration and Monitoring)mentioning

confidence: 99%

“…Caution must be taken with interpretation as levels can be affected by variables such as body position, time of day and medications. Additionally liquorice and grapefruit potentiate the mineralocorticoid effects of hydrocortisone and should thus be avoided [4,11].…”

Section: Mineralocorticoids (Dose Titration and Monitoring)mentioning

confidence: 99%

“…To prevent future crises it is important the preceding medical and behavioral factors are explored including medicine concordance and knowledge of sick day rules. It is also recommended that patients with adrenal insufficiency receive an annual influenza vaccine and pneumococcal vaccination above the age of 60, as well as continuing to alert healthcare staff of their steroid dependent status prior to procedures or in light of acute illness [4,11].…”

Section: Sick Day Rules Emergency Advice and Adrenal Crises Managementmentioning

confidence: 99%

See 4 more Smart Citations

Corticosteroid Replacement Therapy

Onyema¹

2021

Corticosteroids - A Paradigmatic Drug Class

View full text Add to dashboard Cite

The advent of synthetic corticosteroids in the 20th century provided a vital breakthrough in the management of adrenal insufficiency. In this chapter we review the main indications and guidance for appropriate hormone replacement and also look into the management of therapy during special circumstances. For decades hydrocortisone has remained the cornerstone for glucocorticoid replacement but we explore the alternatives including recently introduced modified-release drug preparations and the future treatment considerations currently undergoing research and pre-clinical trials.

show abstract

Section: Glucocorticoid Replacementmentioning

confidence: 99%

Section: Mineralocorticoid Replacementmentioning

confidence: 99%

Section: Glucocorticoids (Dose Titration and Monitoring)mentioning

confidence: 99%

Section: Mineralocorticoids (Dose Titration and Monitoring)mentioning

confidence: 99%

Section: Sick Day Rules Emergency Advice and Adrenal Crises Managementmentioning

confidence: 99%

See 3 more Smart Citations

Corticosteroid Replacement Therapy

Onyema¹

2021

Corticosteroids - A Paradigmatic Drug Class

View full text Add to dashboard Cite

show abstract

Safety of Withholding Perioperative Hydrocortisone for Patients With Pituitary Adenomas With an Intact Hypothalamus-Pituitary-Adrenal Axis

et al. 2022

View full text Add to dashboard Cite

ImportancePituitary adenoma is the second most common primary brain tumor. Perioperative hydrocortisone has been used for decades to avoid postoperative adrenal insufficiency. Recent studies suggest that withholding perioperative hydrocortisone may be safe for patients with an intact hypothalamus-pituitary-adrenal (HPA) axis.ObjectiveTo assess the safety of withholding hydrocortisone during the perioperative period of pituitary adenoma surgery for patients with an intact HPA axis.Design, Setting, and ParticipantsA parallel-group, triple-masked, noninferiority randomized clinical trial was conducted at Peking Union Medical College Hospital from November 1, 2020, to January 31, 2022, among 436 patients aged 18 to 70 years with an intact HPA axis undergoing surgery for pituitary adenomas.InterventionsHydrocortisone supplementation protocol (intravenous and subsequent oral hydrocortisone, using a taper program) or no-hydrocortisone protocol.Main Outcomes and MeasuresThe primary outcome was the incidence of new-onset adrenal insufficiency (morning cortisol level, &lt;5 μg/dL with adrenal insufficiency–related symptoms) during the perioperative period (on the day of operation and the following 2 days). The secondary outcome was the incidence of adrenal insufficiency in postoperative month 3. Analysis was on an intention-to-treat basis.ResultsOf the 436 eligible patients, 218 were randomly assigned to the hydrocortisone group (136 women [62.4%]; mean [SD] age, 45.4 [13.0] years) and 218 to the no-hydrocortisone group (128 women [58.7%]; mean [SD] age, 44.5 [13.8] years). All patients completed 3-month postoperative follow-up. The incidence of new-onset adrenal insufficiency during the perioperative period was 11.0% (24 of 218; 95% CI, 6.9%-15.2%) in the no-hydrocortisone group and 6.4% (14 of 218; 95% CI, 3.2%-9.7%) in the hydrocortisone group, with a difference of 4.6% (95% CI, −0.7% to 9.9%), meeting the prespecified noninferiority margin of 10 percentage points. The incidence of adrenal insufficiency at the 3-month follow-up was 3.7% (8 of 218) in the no-hydrocortisone group and 3.2% (7 of 218) in the hydrocortisone group (difference, 0.5%; 95% CI, −3.0% to 3.9%). Incidences of new-onset diabetes mellitus (1 of 218 [0.5%] vs 9 of 218 [4.1%]), hypernatremia (9 of 218 [4.1%] vs 21 of 218 [9.6%]), hypokalemia (23 of 218 [10.6%] vs 34 of 218 [15.6%]), and hypocalcemia (6 of 218 [2.8%] vs 19 of 218 [8.7%]) were lower in the no-hydrocortisone group than in the hydrocortisone group. Lower preoperative morning cortisol levels were associated with higher risks of the primary event (&lt;9.3 µg/dL; odds ratio, 3.0; 95% CI, 1.5-5.9) and the secondary event (&lt;8.8 µg/dL; odds ratio, 7.8; 95% CI, 2.6-23.4) events.Conclusions and RelevanceThis study found that withholding hydrocortisone was safe and demonstrated noninferiority to the conventional hydrocortisone supplementation regimen regarding the incidence of new-onset adrenal insufficiency among patients with an intact HPA axis undergoing pituitary adenomectomy.Trial RegistrationClinicalTrials.gov Identifier: NCT04621565

show abstract

Identifying hormones and other perioperative risk factors for postoperative delirium after endoscope‐assisted transsphenoidal pituitary adenoma resection: A retrospective, matched cohort study

et al. 2023

View full text Add to dashboard Cite

Objective As a complex and acute brain dysfunction, if postoperative delirium (POD) occurs in the postoperative period, it will lead to a prolonged length of stay in the critical care unit, with increased hospitalization costs and higher mortality. A few case reports inspired us to pay close attention to pituitary tumor‐associated delirium. We hypothesized that the changes in hormone levels after pituitary tumor resection might be associated with POD occurrence. Methods Retrospective analysis was performed on data from a single‐center cohort study conducted at Southwest Hospital between January 2018 and May 2022. A total of 360 patients with pituitary tumors who underwent endoscope‐assisted transsphenoidal pituitary tumor resection were divided into two groups at a 1:3 ratio, with 36 patients in the POD group and 108 patients in the non‐POD group matched by propensity score, age, sex, and tumor size. Basic characteristics, pituitary adenoma features, endocrine levels and other biochemical indicators, and Confusion Assessment Method for the Intensive Care Unit (CAM‐ICU) for postoperative delirium were documented for further analysis. Results Lower insulin‐like growth factor‐1 (IGF‐1, p = .024) and corticotropin‐releasing hormone (CRH, p = .005) levels were closely associated with postoperative delirium and with high levels of blood glucose (GLU, p = .023) after surgery. Subsequent analysis indicated that serum potassium (OR: 0.311, 95% CI 0.103–0.935), sodium (OR: 0.991, 95% CI 0.983–1.000), CRH (OR: 0.964, 95% CI 0.936–0.994), and GLU (OR: 1.654, 95% CI 1.137–2.406) levels in the perioperative period were independent risk factors for delirium. Conclusions Our study indicated that lower serum CRH, potassium, sodium, and GLU levels may be associated with the occurrence of POD after endoscopic‐assisted transsphenoidal surgery. These data provide preliminary evidence for the management of POD in pituitary adenoma patients after surgery. Further studies are needed to identify pharmacological and nonpharmacological multicomponent treatment strategies.

show abstract

Adrenal insufficiency

Cited by 165 publications

References 133 publications

Corticosteroid Replacement Therapy

Corticosteroid Replacement Therapy

Safety of Withholding Perioperative Hydrocortisone for Patients With Pituitary Adenomas With an Intact Hypothalamus-Pituitary-Adrenal Axis

Identifying hormones and other perioperative risk factors for postoperative delirium after endoscope‐assisted transsphenoidal pituitary adenoma resection: A retrospective, matched cohort study

Contact Info

Product

Resources

About