Pazderska Agnieszka, Pearce Simon Hs
Department of Endocrinology, St James's Hospital Dublin, Ireland.
Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
Clin Med (Lond). 2017 Jun;17(3):258-262. doi: 10.7861/clinmedicine.17-3-258.
Adrenal insufficiency is characterised by inadequate -glucocorticoid production owing to destruction of the adrenal cortex or lack of adrenocorticotropic hormone stimulation. In primary adrenal insufficiency, lack of mineralocorticoids is also a feature. Patients can present with an insidious onset of symptoms, or acutely in adrenal crisis, which requires prompt recognition and treatment. Chronic glucocorticoid therapy is the most common cause of adrenal insufficiency. The -diagnosis of adrenal insufficiency is made by -demonstrating low basal and/or stimulated serum cortisol and should be -followed by appropriate investigations to establish the -underlying aetiology. Maintenance glucocorticoid -replacement is usually given as a twice or thrice daily hydrocortisone preparation. Patients with primary adrenal insufficiency also require mineralocorticoid. Regular monitoring for features of under- and over- replacement is essential during follow-up. Patient education is a key feature of management of this condition.
肾上腺功能不全的特征是由于肾上腺皮质破坏或缺乏促肾上腺皮质激素刺激导致糖皮质激素分泌不足。在原发性肾上腺功能不全中，盐皮质激素缺乏也是一个特征。患者可能症状隐匿起病，或在肾上腺危象时急性起病，这需要及时识别和治疗。慢性糖皮质激素治疗是肾上腺功能不全最常见的原因。肾上腺功能不全的诊断是通过证明基础和/或刺激后的血清皮质醇水平低来做出的，并且应该随后进行适当的检查以确定潜在病因。维持性糖皮质激素替代通常给予每日两次或三次的氢化可的松制剂。原发性肾上腺功能不全的患者也需要盐皮质激素。在随访期间，定期监测替代不足和过量的特征至关重要。患者教育是这种疾病管理的一个关键特征。
