Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK
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Introduction Between 1928 and 1938, patients with Addison’s disease had a 100% 5-year mortality ( 1 ). With the availability of glucocorticoid replacement therapy, initially with animal adrenocortical extract and later synthetic 11
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Department of Clinical Biochemistry, Imperial College Healthcare NHS Trust, London, UK
Department of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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Department of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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mineralocorticoid production in primary adrenal failure. The mainstay of treatment is glucocorticoid replacement, with either hydrocortisone or prednisolone ( 2 ). Both work by binding to the glucocorticoid receptor (GR) for which prednisolone has the greater
Diabetes and Endocrine Clinic, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
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therapy? (Once daily (full dose), Twice daily, Three times daily, Four times daily). 5. How do you perceive the impact of Ramadan fasting (RF) on adrenal insufficiency and its management (There is no concern on glucocorticoid replacement therapy
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glucocorticoid replacement therapies ( 21 ). The primary objective of the EU-AIR is to monitor the safety of long-term treatment with once-daily modified-release hydrocortisone and other glucocorticoid replacement therapies in patients with AI. All enrolled
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profiles in adult patients with 21-hydroxylase deficiency have shown a substantial circadian rhythm highly influenced by glucocorticoid replacement ( 6 ). Most recent clinical guideline from the US Endocrine Society suggests levels of androstenedione and 17
Department of Endocrinology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Department of Endocrinology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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within 4 weeks of diagnosis, one study demonstrated a >50% reduction in endogenous steroid production in the 4 weeks after starting glucocorticoid replacement ( 25 ). The nature of Addison’s disease means that endogenous steroid replacement is likely to
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outcomes with current glucocorticoid replacement therapy . Clinical Endocrinology 2015 82 2 – 11 . ( https://doi.org/10.1111/cen.12603 ) 10.1111/cen.12603 25187037 25 Jenkins JS Sampson PA . Conversion of cortisone to cortisol and prednisone to
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Department of Endocrinology, Diabetes and Metabolism, Karolinska University Hospital, Stockholm, Sweden
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Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Adrenal insufficiency is a life-threatening condition requiring chronic glucocorticoid replacement therapy, as well as stress adaptation to prevent adrenal crises. To increase patients’ self-sustainability, education on how to tackle an adrenal crisis is crucial. All patients should carry the European Emergency Card.
Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
Department of Neuroscience DNS, University of Padova, Padova, Italy
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Laboratory Medicine, University-Hospital of Padova, Padova, Italy
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Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
Department of Neuroscience DNS, University of Padova, Padova, Italy
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Laboratory Medicine, University-Hospital of Padova, Padova, Italy
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Endocrine Disease Unit, University-Hospital of Padova, Padova, Italy
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Context
The low-dose short synacthen test (LDSST) is recommended for patients with suspected central adrenal insufficiency (AI) if their basal serum cortisol (F) levels are not indicative of an intact hypothalamic–pituitary–adrenal (HPA) axis.
Objective
To evaluate diagnostic threshold for salivary F before and 30 min after administering 1 μg of synacthen, performed before 09:30 h.
Design
A cross-sectional study from 2014 to 2020.
Setting
A tertiary referral university hospital.
Patients
In this study, 174 patients with suspected AI, 37 with central AI and 137 adrenal sufficient (AS), were included.
Main outcome measure
The diagnostic accuracy (sensitivity (SE), specificity (SP)) of serum and salivary F levels measured, respectively, by chemiluminescence immunoassay and liquid chromatography-tandem mass spectrometry.
Results
Low basal serum or salivary F levels could predict AI. For the LDSST, the best ROC-calculated threshold for serum F to differentiate AI from AS was 427 nmol/L (SE 79%, SP 89%), serum F > 500 nmol/L reached SP 100%. A salivary F peak > 12.1 nmol/L after administering synacthen reached SE 95% and SP 84% for diagnosing central AI, indicating a conclusive reduction in the likelihood of AI. This ROC-calculated threshold for salivary F was similar to the 2.5th percentile of patients with a normal HPA axis, so it was considered sufficient to exclude AI. Considering AS those patients with salivary F > 12.1 nmol/L after LDSST, we could avoid unnecessary glucocorticoid treatment: 99/150 subjects (66%) had an inadequate serum F peak after synacthen, but salivary F was >12.1 nmol/L in 79 cases, who could, therefore, be considered AS.
Conclusions
Salivary F levels > 12.1 nmol/L after synacthen administration can indicate an intact HPA axis in patients with an incomplete serum F response, avoiding the need to start glucocorticoid replacement treatment.
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countries ( 1 ) and the lowest in Japan. Despite the advent of glucocorticoid replacement therapy in the early 1950s, life expectancy remains lower than in the general population ( 2 ), with increased morbidity and impaired quality of life ( 3 , 4
