Adrenal insufficiency resident survival guide: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[ | Shown below is an algorithm summarizing the diagnosis of <nowiki>[[adrenal insufficiency]]</nowiki>. <ref name="BornsteinAllolio2016">{{cite journal|last1=Bornstein|first1=Stefan R.|last2=Allolio|first2=Bruno|last3=Arlt|first3=Wiebke|last4=Barthel|first4=Andreas|last5=Don-Wauchope|first5=Andrew|last6=Hammer|first6=Gary D.|last7=Husebye|first7=Eystein S.|last8=Merke|first8=Deborah P.|last9=Murad|first9=M. Hassan|last10=Stratakis|first10=Constantine A.|last11=Torpy|first11=David J.|title=Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline|journal=The Journal of Clinical Endocrinology & Metabolism|volume=101|issue=2|year=2016|pages=364–389|issn=0021-972X|doi=10.1210/jc.2015-1710}}</ref> <ref>https://www.elsevier.es/index.php?p=revista&pRevista=pdf-simple&pii=S2173509314700698</ref> | ||
{{ | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | | | | | | A01 | | | | | | | | | | |A01=[[Adrenal Insufficiency]] suspected}} | |||
{{familytree | | | | | | | | | | | | | | |!| | | | | | | | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | | B01 | | | | | | | | | | |B01=Serum basal [[cortisol]]}} | |||
{{familytree | | | | |,|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|.| | | | }} | |||
{{familytree | | | | C01 | | | | | | | | C02 | | | | | | | C03 | | | |C01=<5 µg/dL|C02=5-18 µg/dL|C03=>18 µg/dL}} | |||
{{familytree | | | | |!| | | | | | | | | |!| | | | | | | | |!| | | | }} | |||
{{familytree | | | | D01 | | | | | | | | D02 | | | | | | | D03 | | |D01= Confirms [[Adrenal Insufficiency]]|D02=Dynamic tests|D03=Rules out [[Adrenal Insufficiency]]}} | |||
{{familytree | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | | }} | |||
{{familytree | | | | | | |!| | | | | | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | E01 | | | | | | | | | | | | | | E02 | | | | | |E01=Primary [[Adrenal Insufficiency]] suspected |E02= Secondary [[Adrenal Insufficiency]] suspected}} | |||
{{familytree | | | | | | |!| | | | | | | | | | | | | | | |!| | | | | | }} | |||
{{familytree | | | | | | F01 | | | | | | | | | | | | | | F02 | | | | | |F01=[[ACTH]] stimulation test|F02= [[ACTH]] stimulation test}} | |||
{{familytree | | | | |,|-|^|-|.| | | | | | | | |,|-|-|-|-|+|-|-|-|-|.| | }} | |||
{{familytree | | | | G01 | | G02 | | | | | | | G03 | | | G04 | | | G05 | | |G01= Serum cortisol <18 µg/dL|G02= Serum cortisol >18µg/dL|G03= Serum cortisol <18 µg/dL| G04= Serum cortisol 18-23µg/dL| G05= Serum cortisol >23 µg/dL}} | |||
{{familytree | | | | |!| | | |!| | | | | | | | |!| | | | |!| | | | |!| | }} | |||
{{familytree | | | | H01 | | H02 | | | | | | | H03 | | | H04 | | | H05 | |H01= Confirms [[Adrenal Insufficiency]]|H02= Rules out [[Adrenal Insufficiency]]|H03= Confirms [[Adrenal Insufficiency]]| H04= Indeterminate| H05= Rules out [[Adrenal Insufficiency]] }} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | | | |!| | | | | }} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | | | I01 | | | | |I01= Insulin hypoglycemic test}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | |,|-|^|-|.| | | }} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | J01 | | J02 | | |J01= Serum cortisol <18µg/dL| J02= Serum cortisol >18µg/dL}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | |!| | | |!| | }} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | K01 | | K02 | | |K01= Confirms [[Adrenal Insufficiency]]| K02= Rules out [[Adrenal Insufficiency]] }} | |||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 03:34, 14 December 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Primary adrenal insufficiency: Autoimmune adrenalitis
- Central adrenal insufficiency: Chronic glucocorticoid use.
Less common causes:
- Infections:
- Tuberculosis
- Fungal infections(histoplasma)
- Cytomegalovirus
- HIV
- Adrenal hemorrhage
- X-linked adrenoleukodystrophy
- Trauma
- Metastasis [2] [3]
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[adrenal insufficiency]]. [3] [4]
| Adrenal Insufficiency suspected | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Serum basal cortisol | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| <5 µg/dL | 5-18 µg/dL | >18 µg/dL | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Confirms Adrenal Insufficiency | Dynamic tests | Rules out Adrenal Insufficiency | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary Adrenal Insufficiency suspected | Secondary Adrenal Insufficiency suspected | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ACTH stimulation test | ACTH stimulation test | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Serum cortisol <18 µg/dL | Serum cortisol >18µg/dL | Serum cortisol <18 µg/dL | Serum cortisol 18-23µg/dL | Serum cortisol >23 µg/dL | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Confirms Adrenal Insufficiency | Rules out Adrenal Insufficiency | Confirms Adrenal Insufficiency | Indeterminate | Rules out Adrenal Insufficiency | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Insulin hypoglycemic test | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Serum cortisol <18µg/dL | Serum cortisol >18µg/dL | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Confirms Adrenal Insufficiency | Rules out Adrenal Insufficiency | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ https://www.ncbi.nlm.nih.gov/books/NBK499968/
- ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dungan K; et al. (2000). "Endotext". PMID 25905309.
- ↑ 3.0 3.1 Bornstein, Stefan R.; Allolio, Bruno; Arlt, Wiebke; Barthel, Andreas; Don-Wauchope, Andrew; Hammer, Gary D.; Husebye, Eystein S.; Merke, Deborah P.; Murad, M. Hassan; Stratakis, Constantine A.; Torpy, David J. (2016). "Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 101 (2): 364–389. doi:10.1210/jc.2015-1710. ISSN 0021-972X.
- ↑ https://www.elsevier.es/index.php?p=revista&pRevista=pdf-simple&pii=S2173509314700698