Stacey Michael, Gifford Robert M, Woods David
Defence Medical Services and Chelsea and Westminster NHS Foundation Trust, London, UK, senior lecturer, Royal Centre for Defence Medicine, Birmingham, UK, honorary clinical research fellow, Imperial College London, London, UK and visiting research fellow, Leeds Beckett University, Leeds, UK
Defence Medical Services and Western General Hospital, Edinburgh, UK, lecturer, Royal Centre of Defence Medicine, Birmingham, UK and SCREDS clinical lecturer, University of Edinburgh, Edinburgh, UK.
Clin Med (Lond). 2021 Sep;21(5):e541-e542. doi: 10.7861/clinmed.2021-0528.
The National Patient Safety Alert supporting early recognition and treatment of adrenal crisis is a vital new component of care for adults affected by primary adrenal insufficiency. Benefits for patients with secondary and tertiary adrenal insufficiency need to be weighed alongside other considerations such as security of the diagnosis, relative likelihood of adrenal crisis and potential for anxiety and distress from assigning 'physical dependency' in relation to glucocorticoid therapy. All clinicians must be vigilant for and responsive to managing risks of adrenal crisis in at-risk patients, while avoiding diagnostic anchoring in the context of acute illness. More research is required to help define who is at greatest risk of adverse outcomes (including avoidance of therapeutic glucocorticoid therapy for fear of adrenal insufficiency) and a cross-specialty approach is advocated.
支持早期识别和治疗肾上腺危象的国家患者安全警报是对原发性肾上腺皮质功能减退症成年患者护理的重要新组成部分。对于继发性和 tertiary 肾上腺皮质功能减退症患者的益处，需要与其他因素一起权衡，如诊断的安全性、肾上腺危象的相对可能性以及因糖皮质激素治疗而赋予“身体依赖性”所带来的焦虑和痛苦可能性。所有临床医生必须对高危患者肾上腺危象的管理风险保持警惕并做出反应，同时避免在急性疾病背景下进行诊断锚定。需要更多研究来帮助确定谁面临不良后果的风险最大（包括因害怕肾上腺皮质功能减退而避免使用治疗性糖皮质激素治疗），并提倡采用跨专业方法。 （注：这里tertiary 原文有误，推测可能是tertiary，正确应为tertiary，翻译为“第三级的” ）
