MANAGEMENT OF ENDOCRINE DISEASE: Glucocorticoid-induced adrenal insufficiency: replace while we wait for evidence?
| Autor: | Leonie H. A. Broersen, Olaf M. Dekkers, Jens Otto Lunde Jørgensen, Henrik Toft Sørensen, Kristina Laugesen, Simon Bøggild Hansen |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Hypothalamo-Hypophyseal System Hydrocortisone Hormone Replacement Therapy Endocrinology Diabetes and Metabolism Anti-Inflammatory Agents Pituitary-Adrenal System 030209 endocrinology & metabolism law.invention 03 medical and health sciences 0302 clinical medicine Endocrinology Randomized controlled trial law Internal medicine medicine Adrenal insufficiency Humans Hormone replacement therapy Adverse effect Intensive care medicine Glucocorticoids Endocrine disease business.industry General Medicine medicine.disease 030220 oncology & carcinogenesis Observational study business Glucocorticoid medicine.drug Adrenal Insufficiency |
| Zdroj: | Laugesen, K, Broersen, L HA, Hansen, S B, Dekkers, O M, Sørensen, H T & Jørgensen, J O L 2021, ' Management of endocrine disease: Glucocorticoid-induced adrenal insufficiency: Replace while we wait for evidence? ', European Journal of Endocrinology, vol. 184, no. 4, pp. R111-R122 . https://doi.org/10.1530/EJE-20-1199 |
| ISSN: | 1479-683X |
| DOI: | 10.1530/EJE-20-1199 |
| Popis: | Glucocorticoids are, besides non-steroidal anti-inflammatory drugs, the most widely used anti-inflammatory medications. Prevalence studies indicate substantial use of both systemic and locally acting agents. A recognised adverse effect of glucocorticoid treatment is adrenal insufficiency, which is highly prevalent based on biochemical testing, but its clinical implications are poorly understood. Current evidence, including randomised trials and observational studies, indicates substantial variation among patients in both risk and course of glucocorticoid-induced adrenal insufficiency, but both are currently unpredictable. Oral and intra-articular formulations, as well as long-term and high-dose treatments, carry the highest risk of glucocorticoid-induced adrenal insufficiency defined by biochemical tests. However, no route of administration, treatment duration, or dose can be considered without risk. More research is needed to estimate the risk and temporal pattern of glucocorticoid-induced adrenal insufficiency, to investigate its clinical implications, and to identify predictors of risk and prognosis. Randomized trials are required to evaluate whether hydrocortisone replacement therapy mitigates risk and symptoms of glucocorticoid-induced adrenal insufficiency in patients discontinuing glucocorticoid treatment. This review aims to provide an overview of the available evidence, pointing to knowledge gaps and unmet needs. |
| Databáze: | OpenAIRE |
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