TY  - JOUR
A1  - Quinkler, Marcus
A1  - Beuschlein, Felix
A1  - Hahner, Stefanie
A1  - Meyer, Gesine
A1  - Schöfl, Christof
A1  - Stalla, Günter K.
T1  - Adrenal Cortical Insufficiency-a Life Threatening Illness With Multiple Etiologies
JF  - Deutsches Ärzteblatt International
N2  - Background: The clinical signs of adrenal cortical insufficiency (incidence, ca. 25 per million per year; prevalence, ca. 400 per million) are nonspecific, and misdiagnoses are therefore common. Glucocorticoid substitution therapy has been in use for 50 years but is not a wholly adequate treatment. Our understanding of this disease remains incomplete in many ways. 
Methods: We selectively searched the Medline database for publications on adrenal cortical insufficiency, with particular attention to studies from the year 2000 onward (search terms: "adrenal insufficiency" or "Addison's disease" or "hypopituitarism"). Results: Hydrocortisone substitution therapy is often given in doses of 10-25 mg/day, timed according to the circadian rhythm. Gastrointestinal and other, febrile infections account for 30-50% of life-threatening adrenocortical crises. Such crises affect 8 of 100 persons with adrenal cortical insufficiency per year and must be treated by the immediate administration of glucocorticoids and fluids. When persons with adrenal cortical insufficiency are acutely ill or are otherwise under unusual stress, they may need additional amounts of hydrocortisone, often in the range of 5-10 mg but occasionally as high as 200 mg. The sustained administration of excessive amounts of steroid can shorten patients' lives by several years. Inappropriate substitution therapy can cause other major medical conditions, such as metabolic syndrome and osteoporosis. 
Conclusion: Important measures for the prevention of adrenocortical crises include improved care by treating physicians, education of patients and their families, the provision of emergency identifying documents, and the prescription of glucocorticoid emergency kits.
KW  - short term
KW  - subjective health-status
KW  - modified-release hydrocortisone
KW  - glucocorticoid replacement regimens
KW  - Addisons disease
KW  - therapeutic management
KW  - hypopituitary patients
KW  - premature mortality
KW  - circadian therapy
KW  - adult patients
Y1  - 2013
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-131662
VL  - 110
ER  -