Centre for Endocrinology Diabetes and Metabolism (R.K.C., N.A., J.W.T.), University of Birmingham, Edgbaston B15 2TT, United Kingdom; and University of Leeds School of Medicine (P.M.S.), Leeds LS2 9NL, United Kingdom.
J Clin Endocrinol Metab. 2014 Nov;99(11):4027-36. doi: 10.1210/jc.2014-2476. Epub 2014 Aug 20.
Central hypoadrenalism is a frequent complication of pituitary and hypothalamic pathology and is associated with increased morbidity and mortality. Optimal exogenous glucocorticoid use is dependent on the use of appropriate diagnostic tests and careful assessment of the clinical response to glucocorticoid replacement therapy.
A PubMed search for the terms central hypoadrenalism, ACTH deficiency, glucocorticoid suppression, and glucocorticoid replacement was conducted; the papers identified and the references listed were used to build a reference list.
The published literature was assessed to present a summary of the available evidence with regard to etiology, diagnosis, and treatment of central hypoadrenalism.
A functional hypothalamic pituitary adrenal axis is essential for normal health and life expectancy; its complexity presents challenges to the clinician in the identification of patients and in the maintenance of such patients in a glucocorticoid-sufficient state. The most common cause of central hypoadrenalism remains exogenous glucocorticoid use. Further research in this field should be directed toward disease prevention by minimizing glucocorticoid exposure and toward the identification of a biomarker for glucocorticoid sufficiency that will aid clinicians in optimizing treatment.
中枢性肾上腺功能减退症是垂体和下丘脑病变的常见并发症，与发病率和死亡率的增加有关。最佳外源性糖皮质激素的使用取决于适当的诊断测试的使用和对外源性糖皮质激素替代治疗的临床反应的仔细评估。
对术语“中枢性肾上腺功能减退症、ACTH 缺乏症、糖皮质激素抑制、糖皮质激素替代”进行了 PubMed 搜索；确定了所确定的论文和列出的参考文献，以构建参考列表。
评估了已发表的文献，以提供有关中枢性肾上腺功能减退症的病因、诊断和治疗的现有证据的摘要。
功能性下丘脑-垂体-肾上腺轴对于正常的健康和预期寿命至关重要；其复杂性对临床医生在识别患者和维持此类患者处于糖皮质激素充足状态方面提出了挑战。中枢性肾上腺功能减退症的最常见原因仍然是外源性糖皮质激素的使用。该领域的进一步研究应致力于通过最小化糖皮质激素暴露来预防疾病，并确定糖皮质激素充足的生物标志物，以帮助临床医生优化治疗。
