Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

Endocrine Journal

Tomonobu Hasegawa³  Toshihiko Yanase⁴  Tomoatsu Mune⁹  Soji Kasayama⁷  Masatoshi Nomura⁵  Makito Tanabe⁴  Toshihiro Tajima²  Takuyuki Katabami^1,15  Akira Sugawara^1,13  Michio Otsuki⁶  Nobuhiro Miyamura¹  Yasumasa Iwasaki^1,11  Yuichi Nakagawa^1,14  Chikara Shimizu^1,10  Yusuke Tanahashi⁸  Yuko Akehi⁴  Yutaka Oki^1,12 

[1] Tamana Central Hospital, Tamana 865-0064, Japan;Jichi Children’s Medical Center Tochigi, Pediatrics, Shimotsuke 329-0498, Japan;Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan;Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoa 814-0180, Japan;Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, Fukuoka 812-8582, Japan;Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan;Nissay Hospital, Osaka 550-0012, Japan;Department of Pediatrics, Asahikawa Medical University, Sapporo 078-8510, Japan;Division of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki 701-0192, Japan;Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo 060-8638, Japan;Health Service Center, Kochi University, Nankoku 780-8520, Japan;Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan;Department of Advanced Biological Sciences for Regeneration, Tohoku University, Graduate School of Medicine, Sendai 980-8575, Japan;Shiraume Toyooka Hospital, Iwata 438-0126, Japan;Division of Metabolism and Endocrinology, Department of Internal Medicine, St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama 241-0811, Japan

关键词: Adrenal insufficiency;    Adrenal crisis;    Cortisol;    Hydrocortisone;    Congenital adrenal hyperplasia;   

DOI  :  10.1507/endocrj.EJ16-0242

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(98)This clinical practice guideline of the diagnosis and treatment of adrenal insufficiency (AI) including adrenal crisis was produced on behalf of the Japan Endocrine Society.This evidence-based guideline was developed by a committee including all authors, and was reviewed by a subcommittee of the Japan Endocrine Society.The Japanese version has already been published, and the essential points have been summarized in this English language version.We recommend diagnostic tests, including measurement of basal cortisol and ACTH levels in combination with a rapid ACTH (250 μg corticotropin) test, the CRH test, and for particular situations the insulin tolerance test.Cut-off values in basal and peak cortisol levels after the rapid ACTH or CRH tests are proposed based on the assumption that a peak cortisol level ≥18 μg/dL in the insulin tolerance test indicates normal adrenal function.In adult AI patients, 15-25 mg hydrocortisone (HC) in 2-3 daily doses, depending on adrenal reserve and body weight, is a basic replacement regime for AI.In special situations such as sickness, operations, pregnancy and drug interactions, cautious HC dosing or the correct choice of glucocorticoids is necessary.From long-term treatment, optimal diurnal rhythm and concentration of serum cortisol are important for the prevention of cardiovascular disease and osteoporosis.In maintenance therapy during the growth period of patients with 21-hydroxylase deficiency, proper doses of HC should be used, and long-acting glucocorticoids should not be used.Education and carrying an emergency card are essential for the prevention and rapid treatment of adrenal crisis.

【 授权许可】

Unknown