Oelkers W, Diederich S, Bähr V
Division of Endocrinology, Klinikum Benjamin Franklin, Freie Universität Berlin Hindenburgdamm 30, 12200 Berlin, Germany.
Ann Endocrinol (Paris). 2001 Apr;62(2):212-6.
Severe chronic adrenal insufficiency (primary or secondary) is a potentially lethal disorder, unless the patient is regularly substituted with glucocorticoids, usually with hydrocortisone (15-25 mg/day) and with 9 alpha-fluor-hydrocortisone (0.05-0.2 mg/day) in addition in patients with the primary adrenal disorder (Addison's disease). In stressful situations and in febrile disorders, the glucocorticoid dosage must be increased prophylactically in order to prevent an "adrenal crisis". Most women with adrenal insufficiency will profit from the additional substitution of dehydroepiandrosterone (DHEA) with regard to well-being and sexual function. A patient with acute adrenal insufficiency will die if the diagnosis is missed and high-dose glucocorticoid treatment is not instituted immediately. Acute adrenal insufficiency developing de novo in an intensive care patient (e.g. from adrenal hemorrhage or adrenal vein thrombosis) is a most challenging diagnosis. In these patients, however, survival not only depends on glucocorticoid substitution but also on the underlying disease.
严重慢性肾上腺皮质功能减退（原发性或继发性）是一种潜在的致命性疾病，除非患者定期接受糖皮质激素替代治疗，通常使用氢化可的松（15 - 25毫克/天），对于原发性肾上腺疾病（艾迪生病）患者还需加用9α-氟氢化可的松（0.05 - 0.2毫克/天）。在应激状态和发热性疾病时，必须预防性增加糖皮质激素剂量以防止“肾上腺危象”。大多数肾上腺皮质功能减退的女性在补充脱氢表雄酮（DHEA）后，身心健康和性功能会得到改善。如果漏诊急性肾上腺皮质功能减退且未立即进行大剂量糖皮质激素治疗，患者将会死亡。重症监护患者新发急性肾上腺皮质功能减退（如因肾上腺出血或肾上腺静脉血栓形成）是极具挑战性的诊断。然而，这些患者的存活不仅取决于糖皮质激素替代治疗，还取决于基础疾病。
