Group 1. Epidemiology of primary and secondary adrenal insufficiency: Prevalence and incidence, acute adrenal insufficiency, long-term morbidity and mortality

2017 ◽  
Vol 78 (6) ◽  
pp. 490-494 ◽  
Author(s):  
Olivier Chabre ◽  
Bernard Goichot ◽  
Delphine Zenaty ◽  
Jérôme Bertherat
Keyword(s):  
Adrenal Insufficiency ◽  
Morbidity And Mortality ◽  
Secondary Adrenal Insufficiency ◽  
Acute Adrenal Insufficiency ◽  
Group 1

scholarly journals Secondary Adrenal Insufficiency after Treatment with Budesonide for Autoimmune Hepatitis

2018 ◽  
Vol 12 (3) ◽  
pp. 597-601 ◽  
Author(s):  
Filip De Maeyer ◽  
Bruno Lapauw ◽  
Anne Hoorens ◽  
Anja Geerts ◽  
Hans Van Vlierberghe ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
Adrenal Insufficiency ◽  
Attractive Alternative ◽  
Secondary Adrenal Insufficiency ◽  
Systemic Activity ◽  
Immunosuppressive Medication ◽  
Systemic Corticosteroids ◽  
First Case ◽  
First Pass

Autoimmune hepatitis (AIH) is a rare cause of chronic liver disease. The backbone of treatment is immunosuppressive medication, typically prednisolone as induction therapy and azathioprine as a maintenance therapy. Side effects of the long-term use of systemic corticosteroids are well known and have led to the use of alternative induction regimens. An attractive alternative is budesonide, a nonhalogenated glucocorticosteroid characterized by a high first-pass effect in the liver (90%), resulting in a high topical anti-inflammatory activity and a low systemic activity. It should be stressed that budesonide is contraindicated in patients with established cirrhosis with portal hypertension and portocaval shunting. In this case report, we present the first case of adrenal insufficiency following treatment with budesonide for AIH.

scholarly journals Reduction in daily hydrocortisone dose improves bone health in primary adrenal insufficiency

2016 ◽  
Vol 174 (4) ◽  
pp. 531-538 ◽  
Author(s):  
Julia Schulz ◽  
Kathrin R Frey ◽  
Mark S Cooper ◽  
Kathrin Zopf ◽  
Manfred Ventz ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Crisis ◽  
Mineral Density ◽  
Primary Adrenal Insufficiency ◽  
Group Reduction ◽  
Group 3 ◽  
Group 2 ◽  
Over Time ◽  
Group 1

ObjectiveIndividuals with primary adrenal insufficiency (PAI) or congenital adrenal hyperplasia (CAH) receive life-long glucocorticoid (GC) replacement therapy. Current daily GC doses are still higher than the reported adrenal cortisol production rate. This GC excess could result in long-term morbidities such as osteoporosis. No prospective trials have investigated the long-term effect of GC dose changes in PAI and CAH patients.MethodsThis is a prospective and longitudinal study including 57 subjects with PAI (42 women) and 33 with CAH (21 women). Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry at baseline and after 2 years. Subjects were divided into three groups (similar baseline characteristics) depending on changes in daily hydrocortisone equivalent dose (group 1: unchanged 25.2±8.2 mg (mean±s.d., n=50); group 2: increased 18.7±10.3 to 25.9±12.0 mg (n=13); group 3: decreased 30.8±8.5 to 21.4±7.2 mg (n=27)).ResultsSubjects in group 1 showed normal lumbar and femoral Z-scores which were unchanged over time. Group 2 subjects showed a significant decrease in femoral neck Z-scores over time (−0.15±1.1 to −0.37±1.0 (P<0.05)), whereas group 3 subjects showed a significant increase in lumbar spine and hip Z-scores (L1–L4: −0.93±1.2 to –0.65±1.5 (P<0.05); total hip: −0.40±1.0 to −0.28±1.0 (P<0.05)). No changes in BMI over time were seen within any group. Reduction in GC dose did not increase the risk of adrenal crisis.ConclusionThis study demonstrates for the first time that cautious reduction in hydrocortisone equivalent doses leads to increases in BMD, whereas dose increments reduced BMD. These data emphasize the need for the lowest possible GC replacement dose in AI patients to maintain health and avoid long-term adverse effects.

scholarly journals P.089 Recovery from chronic secondary adrenal insufficiency in patients with pituitary disorders

2016 ◽  
Vol 43 (S2) ◽  
pp. S41-S41
Author(s):  
V Munro ◽  
B Tugwell ◽  
S Doucette ◽  
DB Clarke ◽  
A Lacroix ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Tumour Size ◽  
Pituitary Surgery ◽  
Complete Recovery ◽  
Glucocorticoid Therapy ◽  
Hormone Deficiency ◽  
Secondary Adrenal Insufficiency ◽  
Glucocorticoid Treatment ◽  
Acth Secreting

Background: Patients with pituitary disorders may be placed on steroid replacement for secondary adrenal insufficiency (SAI), generally after pituitary surgery; however, data regarding recovery of long-term SAI are lacking. We conducted a study to assess the longer term recovery rate of SAI in patients with pituitary disorders. Methods: We identified all SAI patients from prospectively entered data in the Halifax Neuropituitary Database from November 1, 2005 to September 30, 2014, who had required glucocorticoid therapy for >3 months, and a minimum follow-up of 6 months. Exclusion: ACTH-secreting adenomas; peri-operative glucocorticoid treatment only; glucocorticoids for non-pituitary conditions. Results: 55 patients fulfilled the criteria, 41 (75%) of which had transsphenoidal surgery. Nine (16.4%) patients had complete recovery of SAI over a median of 20 months (range: 8–51). Smaller tumour size and initial cortisol >175 nmol/L had increased likelihood of recovery; those with secondary hypogonadism or growth hormone deficiency were less likely to recover. Conclusions: This is the first study to examine long-term recover of SAI in patients with pituitary disorders: approximately 1 in 6 patients recover adrenal function, up to 5 years after diagnosis. Consequently, patients with SAI should undergo regular testing to prevent unnecessary chronic glucocorticoid therapy.

scholarly journals Pediatric Adrenal Insufficiency: Diagnosis, Management, and New Therapies

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Sasigarn A. Bowden ◽  
Rohan Henry
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Cortex ◽  
Clinical Management ◽  
Current Treatment ◽  
Treatment Recommendations ◽  
Morbidity And Mortality ◽  
Secondary Adrenal Insufficiency ◽  
Primary Adrenal Insufficiency ◽  
New Therapies ◽  
Timely Diagnosis

Adrenal insufficiency may result from a wide variety of congenital or acquired disorders of hypothalamus, pituitary, or adrenal cortex. Destruction or dysfunction of the adrenal cortex is the cause of primary adrenal insufficiency, while secondary adrenal insufficiency is a result of pituitary or hypothalamic disease. Timely diagnosis and clinical management of adrenal insufficiency are critical to prevent morbidity and mortality. This review summarizes the etiologies, presentation, and diagnosis of adrenal insufficiency utilizing different dynamic hormone testing and describes current treatment recommendations and new therapies.

Abstract 13347: Effect of Severe Anemia (hemoglobin < 10g/dl) on Short- and Long-term Outcome in Acute Coronary Syndrome: Insights of a Terciary Centre

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Isabel Campos ◽  
Cátia Oliveira ◽  
Paulo Medeiros ◽  
Carla Marques Pires ◽  
Rui Flores ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Morbidity And Mortality ◽  
Severe Anemia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Short And Long Term ◽  
Group 2 ◽  
Group 1

Introduction: Although invasive strategies are the generalized approach in the management of ACS pts, their benefits in pts with significant anemia are unclear, as anemia is strongly associated with increased risk of morbidity and mortality. Aim: To determine the incidence and the impact of severe anemia (hemoglobin<10g/dL) on short- and long-term outcome in pts hospitalized with ACS. Methods: We analyzed retrospectively 2905 ACSpts admitted for 6 years in our CCU. Pts were divided into two groups: group 1-pts with severe anemia(hemoglobin < 10g/dL) (n=257,8.8%); group 2-pts without severe anemia (hemoglobin >=10g/dL) (n=2648,91.2%). Primary endpoint was the occurrence of a composite of death and adverse cardiovascular events (stroke, reinfarction, and rehospitalization of cardiovascular etiology) at 6 months; FU was completed in 96%pts. Results: The sample consisted in 77.9% men and 22.1% women, with mean age of 64±13 years. The incidence of severe anemia was 8.8%. Group1 pts were older (p<0.001), had a higher proportion of women (p<0.001), diabetes (p<0.001), CKD (p<0.001) and AF (p<0.001). During hospitalization, group 1 had more HF (p<0.001), angor (p<0.001), refarction (p=0.006), bleeding (p<0.001) and transfusion (p<0.001). Group 1 had a higher proportion of NSTEMI (p=0.009) as opposed to group2 which had more STEMI (p=0.031). During hospitalization, group 2 pts were more likely to undergo revascularization (p<0.001). A multivariate analysis identified age [OR 1.06, 95%CI 1.04 to 1.07; p<0.001] and feminine sex [OR 2.61, 95%CI 1.89 to 3.61; p<0.001] as independent predictors of severe anemia during hospitalization. Pts with severe anemia had higher 6-month mortality (32.1%vs6.9%;p<0.001). In multivariate analysis and after adjusting for different baseline characteristics, pts with severe anemia had higher occurrence of a composite of death and MACE at 6months [OR5.04,95%CI 1.21 to 21.04;p=0.026]. Conclusion: Severe anemia was strongly associated with increased risk of morbidity and mortality in ACS pts. However, pts with severe anemia who were double antiaggregated had no worse outcomes than those who had simple antiaggregation after 6months. Therefore, there was no significant difference regarding revascularization in these pts.

Repetitive and continuous administration of human corticotropin releasing factor to human subjects

1986 ◽  
Vol 112 (2) ◽  
pp. 157-165 ◽  
Author(s):  
J. Schopohl ◽  
A. Hauer ◽  
T. Kaliebe ◽  
G. K. Stalla ◽  
K. von Werder ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Bolus Injection ◽  
Human Subjects ◽  
Normal Subjects ◽  
Pituitary Hormones ◽  
Corticotropin Releasing Factor ◽  
Secondary Adrenal Insufficiency ◽  
Continuous Administration ◽  
Pulsatile Administration

Abstract. ACTH secretion was studied in response to repetitive and continuous administration of human corticotropin releasing factor (CRF) in 14 healthy volunteers and 2 patients with secondary adrenal insufficiency. ACTH increases during repetitive CRF administration were within the same range in normal subjects independent of the intervals (60– 180 min) between the CRF pulses (100 μg iv). When CRF was infused continuously (100 μg/h for 3 h) after an initial CRF bolus injection (100 μg iv), ACTH and cortisol remained elevated during the infusion at a nearly constant level (ACTH: 60 ± 5 pg/ml; cortisol: 21.2 ± 1 μg/dl; x̄ ± se). A second CRF bolus injection at the end of the infusion did not lead to a significant further increase of ACTH and cortisol levels. This shows that there is no desensitisation or depletion of a ready releasable pool, as it is observed with other pituitary hormones after releasing hormone stimulation. Pulsatile administration of CRF in 2 patients with secondary adrenal insufficiency due to previous cortisol or glucocorticoid excess, respectively, revealed a blunted response to the first pulse which became normal after the following pulses. The latter could not be sustained until the next morning without CRF given overnight. These findings point to a hypothalamic defect being the cause of hypocortisolism after long-term cortisol suppression.

Full Mortality risk in patients with adrenal insufficiency using Prednisolone or Hydrocortisone: A Retrospective Cohort study

2021 ◽  
Author(s):  
Kanchana Ngaosuwan ◽  
Desmond G Johnston ◽  
Ian F Godsland ◽  
Jeremy Cox ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Secondary Adrenal Insufficiency ◽  
Duration Of Action ◽  
Statistical Adjustment ◽  
Expected Mortality ◽  
Care Database

Abstract Context Prednisolone has been recommended rather than hydrocortisone for glucocorticoid replacement in adrenal insufficiency due its longer duration of action and lower cost. Objective To determine mortality rates with prednisolone versus hydrocortisone. Design Observational study. Setting A UK primary care database (Clinical Practice Research Datalink). Participants Patients with primary and secondary adrenal insufficiency, treated with either prednisolone or hydrocortisone, and controls individually matched for age, sex, period and place of follow-up. Interventions Nil Outcomes Mortality relative to individually matched controls. Results As expected, mortality in adrenal insufficiency irrespective of cause was increased, based on 5478 patients (4228 on hydrocortisone; 1250 on prednisolone) and 54314 controls (41934 and 12380, respectively). Overall, the adjusted hazard ratio (HR) was similar with the two treatments (prednisolone, 1.76 [95% CI, 1.54-2.01] vs. hydrocortisone 1.69 [1.57-1.82]; p=0.65). This was also the case for secondary adrenal insufficiency. In primary disease (1405 on hydrocortisone vs. 137 on prednisolone:13965 and 1347 controls, respectively), prednisolone-users were older, more likely to have another autoimmune disease and malignancy, and less likely to have mineralocorticoid replacement. Nevertheless, after adjustment, the HR for prednisolone-treated patients remained higher than for those taking hydrocortisone (2.92 [2.19-3.91] vs. 1.90 [1.66-2.16]; p=0.0020). Conclusions In primary but not in secondary adrenal insufficiency mortality was higher with prednisolone. The study was large, but the number of prednisolone-treated patients was small, and they had greater risk factors. Nonetheless the increased mortality associated with prednisolone persisted despite statistical adjustment. Further evidence is needed regarding the long-term safety of prednisolone as routine replacement.

scholarly journals MON-304 Prolactin as a Surrogate Marker to Predict Long Term Postoperative Hypopituitarism After Transsphenoidal Resection of Pituitary Adenomas

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Massiell German ◽  
Devaprabu Abraham ◽  
William Couldwell ◽  
Debra L Simmons ◽  
Anu Sharma
Keyword(s):  
Adrenal Insufficiency ◽  
Pituitary Adenomas ◽  
Surrogate Marker ◽  
Older Age ◽  
Pituitary Function ◽  
Secondary Adrenal Insufficiency ◽  
Secondary Hypothyroidism ◽  
Tertiary Center

Abstract Transsphenoidal surgery (TSS) is the first line treatment for pituitary adenoma. A well-known complication of TSS is hypopituitarism with a reported risk of 5-25% after resection of pituitary adenomas. A decrease in postoperative prolactin concentration was shown to be associated with postoperative hypopituitarism in a previous report. We hypothesized that in addition to clinical factors (preoperative hypofunction and adenoma size), biochemical factors (change in prolactin concentration and immediate post-operative hypofunction) can aid in predicting long term hypopituitarism as defined as ≥1 biochemically confirmed hypofunctioning pituitary axes 3 years after resection. A retrospective analysis of all patients undergoing TSS for both functioning and non-functioning pituitary adenomas at a tertiary center from January 2013 through December 2015 was performed. Prolactinomas were excluded. Of the 75 patients included, 21.3% (n=16) had at least one pituitary axis requiring replacement at 3 years post operatively. Mean age at presentation was 55 ± 16 years, 55% were female and 81% were Caucasian. Mean adenoma size was no different between normal pituitary function and hypopituitary groups (24.0 ± 11.9 mm versus 25.3 ± 10, p=0.7). Factors associated with long term hypopituitarism were older age (mean age 64 ± 4 years versus 53 ± 2 years, p = 0.02), preoperative secondary adrenal insufficiency (AM cortisol 6.4 ± 3.7 vs 12.0 ± 6.5 µg/dL; p = 0.03), preoperative secondary hypothyroidism (0.8 ± 0.2 vs 12.0 ± 6.5 ng/dL; p &lt; 0.01), low immediate postoperative cortisol (5.3±3.1 vs 26.1±18.3 µg/d; p&lt;0.01), and persistence of adrenal insufficiency (10.7% vs 2.7%; p&lt;0.01) and secondary hypothyroidism (13.3% vs 5.3%; p&lt;0.01) at 3 months. Change in prolactin concentration from preoperative to postoperative day 1-7 was not significantly different between groups (p=0.09) due to the higher variability in the hypopituitary group (median 0.2 ng/mL, IQR -0.5 - 0.8 ng/mL) compared to the normal pituitary function group (median 0.7 ng/mL, IQR 0.5-0.8 ng/mL). Adenoma size, optic chiasm and cavernous sinus involvement were not associated with long term hypopituitarism. In patients who developed postoperative hypopituitarism, there was a higher frequency of adenoma persistence or recurrence (20% vs 47%). There was a high rate of patients lost to follow up (56%). Older age, the presence of preoperative secondary adrenal insufficiency and hypothyroidism, and low day 1-7 postoperative cortisol concentration are factors that can be used to deem a patient high risk for future hypopituitarism. These patients should have close follow up with continued screening postoperatively. Contrary to prior reports, adenoma size and parasellar involvement were not associated which may be suggestive of surgical expertise. Prolactin concentrations proved not to be a good surrogate marker to predict long term hypopituitarism.

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