Relative Adrenal Insufficiency: Crisis Averted?

2021 ◽  
Vol 40 (6) ◽  
pp. 369-376
Author(s):  
Lindsay Elise Holmstrom ◽  
Amy J. Jnah
Keyword(s):  
Risk Factors ◽  
Adrenal Gland ◽  
Adrenal Insufficiency ◽  
Disease Process ◽  
Adrenal Crisis ◽  
Relative Adrenal Insufficiency ◽  
Live Births ◽  
Functional Development ◽  
Common Risk Factors ◽  
Made In

Relative adrenal insufficiency (AI) is a disease process commonly associated with preterm birth and critical illness. Further, the incidence of AI is inversely proportional to gestational age. The incidence of AI is likely underreported; however, it is reported to occur in 150–280/1,000,000 live births worldwide. Functional development of the adrenal gland does not occur until after 30 weeks of gestation; however, advances made in neonatal care increase the survivability of infants born well before this period. Among infants with AI, the adrenal gland is transiently incapable of secreting physiologic levels of cortisol in response to stressors. Common and nonspecific signs include hypotension, poor perfusion, and dysregulation of fluid, electrolytes, and euglycemia. Recognition, diagnosis, and steroid therapy is critical, as inappropriately managed AI can lead to an adrenal crisis, shock, and death. Understanding the presentation and common risk factors for developing relative AI is crucial for quick diagnosis and timely management to prevent morbidity and mortality in this vulnerable population.

scholarly journals Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies

2010 ◽  
Vol 162 (3) ◽  
pp. 597-602 ◽  
Author(s):  
Stefanie Hahner ◽  
Melanie Loeffler ◽  
Benjamin Bleicken ◽  
Christiane Drechsler ◽  
Danijela Milovanovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adrenal Insufficiency ◽  
Educational Status ◽  
Cross Sectional Study ◽  
Sudden Onset ◽  
Stressful Events ◽  
Adrenal Crisis ◽  
Cross Sectional ◽  
Crisis Prevention ◽  
Dhea Treatment

ObjectiveAdrenal crisis (AC) is a life-threatening complication of adrenal insufficiency (AI). Here, we evaluated frequency, causes and risk factors of AC in patients with chronic AI.MethodsIn a cross-sectional study, 883 patients with AI were contacted by mail. Five-hundred and twenty-six patients agreed to participate and received a disease-specific questionnaire.ResultsFour-hundred and forty-four datasets were available for analysis (primary AI (PAI), n=254; secondary AI (SAI), n=190). Forty-two percent (PAI 47% and SAI 35%) reported at least one crisis. Three hundred and eighty-four AC in 6092 patient years were documented (frequency of 6.3 crises/100 patient years). Precipitating causes were mainly gastrointestinal infection and fever (45%) but also other stressful events (e.g. major pain, surgery, psychic distress, heat and pregnancy). Sudden onset of apparently unexplained AC was also reported (PAI 6.6% and SAI 12.7%). Patients with PAI reported more frequent emergency glucocorticoid administration (42.5 vs 28.4%, P=0.003). Crisis incidence was not influenced by educational status, body mass index, glucocorticoid dose, DHEA treatment, age at diagnosis, hypogonadism, hypothyroidism or GH deficiency. In PAI, patients with concomitant non-endocrine disease were at higher risk of crisis (odds ratio (OR)=2.02, 95% confidence interval (CI) 1.05–3.89, P=0.036). In SAI, female sex (OR=2.18, 95% CI 1.06–4.5, P=0.035) and diabetes insipidus (OR=2.71, 95% CI 1.22–5.99, P=0.014) were associated with higher crisis incidence.ConclusionAC occurs in a substantial proportion of patients with chronic AI, mainly triggered by infectious disease. Only a limited number of risk factors suitable for targeting prevention of AC were identified. These findings indicate the need for new concepts of crisis prevention in patients with AI.

scholarly journals Risk Factors for Adrenal Crisis in Patients with Adrenal Insufficiency

2003 ◽  
Vol 50 (6) ◽  
pp. 745-752 ◽  
Author(s):  
Kazue OMORI ◽  
Kaoru NOMURA ◽  
Satoru SHIMIZU ◽  
Nariko OMORI ◽  
Kazue TAKANO
Keyword(s):  
Risk Factors ◽  
Adrenal Insufficiency ◽  
Adrenal Crisis

An Approach to Minimising Risk of Adrenal Insufficiency When Discontinuing Oral Glucocorticoids

2017 ◽  
Vol 22 (2) ◽  
pp. 175-181
Author(s):  
Mathew N. Nicholas ◽  
Stephanie K. Li ◽  
Marlene Dytoc
Keyword(s):  
Risk Factors ◽  
Adrenal Gland ◽  
Adrenal Insufficiency ◽  
Adrenocorticotropic Hormone ◽  
Adrenal Glands ◽  
Review Article ◽  
Adrenal Suppression ◽  
Basal Cortisol ◽  
Stimulation Tests ◽  
Oral Glucocorticoids

Oral glucocorticoids are commonly used across every field of medicine; however, discontinuing them in patients can be challenging. The risk of acute adrenal crises secondary to glucocorticoid withdrawal can be fatal and arises from chronic suppression of the adrenal glands. Identifying risk factors for adrenal suppression in dermatological patients, such as doses greater than 5 to 7.5 mg of prednisone equivalent, duration of glucocorticoid use greater than 3 weeks, certain medications, and comorbidities, can help risk-stratify patients. The use of adrenal gland testing such as basal cortisol levels and adrenocorticotropic hormone stimulation tests can confirm adrenal suppression in patients. This review article provides an approach that dermatologists can use to minimise the risk of adrenal insufficiency in patients discontinuing glucocorticoids and when it may be appropriate to use adrenal gland testing.

Adrenal crisis in patients with primary and secondary adrenal insufficiency

2006 ◽  
Vol 114 (S 1) ◽  
Author(s):  
S Hahner ◽  
M Löffler ◽  
D Weismann ◽  
AC Koschker ◽  
M Fassnacht ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenal Crisis ◽  
Secondary Adrenal Insufficiency

The Role of IL-1, IL-6, TNF-α and MIF in Relative Adrenal Insufficiency in Septic Shock: A Study in Piglet Model

2018 ◽  
Author(s):  
Bina Akura ◽  
Jose Batubara ◽  
Zakiudin Munasir ◽  
Gunati unknown ◽  
Joedo Prihartono ◽  
...  
Keyword(s):  
Septic Shock ◽  
Adrenal Insufficiency ◽  
Relative Adrenal Insufficiency ◽  
Tnf Α

scholarly journals Case Report: Papillary Thyroid Cancer in a Patient with Celiac Disease and Thalassemia Trait

2020 ◽  
Vol 13 (3) ◽  
pp. 1364-1367
Author(s):  
Afaf Albattah ◽  
Yahia Imam ◽  
Ahmed Osman Saleh ◽  
Khalid Ahmed ◽  
Tarek Aboursheid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
Celiac Disease ◽  
Case Report ◽  
Papillary Thyroid Cancer ◽  
Thalassemia Major ◽  
Papillary Thyroid ◽  
Unique Case ◽  
Thalassemia Trait ◽  
Common Risk Factors

Thyroid cancer is the most frequent endocrine neoplasm in the general population. Common risk factors include gender, radiation exposure, and genetic backgrounds. The association of papillary thyroid cancer and celiac disease has frequently been reported in the literature; however, the association of papillary thyroid cancer and thalassemia trait is rare. Likewise, the association of thalassemia major and celiac disease is also rare. We hereby report a unique case of papillary thyroid cancer in a patient with celiac disease and thalassemia trait.

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