Academic Department of Endocrinology, Beaumont Hospital/RCSI, Dublin, Ireland.
Academic Department of Endocrinology, Beaumont Hospital/RCSI, Dublin, Ireland.
Clin Chim Acta. 2020 Jun;505:148-159. doi: 10.1016/j.cca.2020.03.006. Epub 2020 Mar 5.
Glucocorticoid deficiency is the clinical state characterised by inadequate cortisol production. It may occur due to the primary failure of the adrenal cortex or to lack of stimulation of the adrenal cortex by adrenocorticotropic hormone. The aim of treatment of glucocorticoid deficiency is to mimic the normal physiological secretion of cortisol, in order to normalise quality of life and reverse pathological sequelae. However, the diurnal rhythm of cortisol secretion is difficult to reproduce with exogenous glucocorticoid therapy. There is wide inter- and intra-individual variability of in the dynamics of physiological glucocorticoid secretion, and glucocorticoid preparations that are currently available cannot reproduce physiological profiles. In addition, there are no reliable biomarkers to determine the adequacy of treatment. The treatment of acute glucocorticoid deficiency/ adrenal crisis involves prompt recognition and administration of parenteral hydrocortisone, rehydration, and management of electrolyte abnormalities. In the management of chronic glucocorticoid deficiency, the prevention of adrenal crisis must be balanced with avoidance of the long-term adverse effects of over-replacement. This requires close collaboration with the patient, for whom education and empowerment in the management of glucocorticoid deficiency, and the prevention of crises, are crucial.
糖皮质激素缺乏是指由于肾上腺皮质本身的疾病或 ACTH 缺乏所致皮质醇生成不足的临床状态。糖皮质激素缺乏的治疗目的是模拟皮质醇的正常生理分泌，以恢复生活质量并逆转病理后果。然而，外源性糖皮质激素治疗很难复制皮质醇的昼夜节律分泌。生理糖皮质激素分泌的动力学存在广泛的个体内和个体间变异性，目前可用的糖皮质激素制剂无法复制生理谱。此外，目前还没有可靠的生物标志物来确定治疗的充分性。急性糖皮质激素缺乏症/肾上腺危象的治疗包括及时识别和给予静脉用氢化可的松、补液和纠正电解质异常。在慢性糖皮质激素缺乏症的管理中，必须在预防肾上腺危象和避免过度替代的长期不良影响之间取得平衡。这需要与患者密切合作，对患者进行有关糖皮质激素缺乏症管理和预防危象的教育和授权至关重要。
