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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Updated: May 28, 2025

Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
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[Glucocorticoid-induced adrenal insufficiency].

Marcus Imamovic1, Per Dahlqvist2, Oskar Ragnarsson3

  • 1ST-läkare, Medicincentrum, Norrlands universitetssjukhus, Umeå.

Lakartidningen
|February 12, 2025
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Summary

Glucocorticoid-induced adrenal insufficiency is often missed and can increase mortality. New guidelines and a corticosteroid treatment card aim to improve diagnosis and prevent adrenal crisis in patients on long-term glucocorticoid therapy.

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Area of Science:

  • Endocrinology
  • Pharmacology

Background:

  • Glucocorticoid-induced adrenal insufficiency is an underdiagnosed condition.
  • This condition may contribute to increased patient mortality.
  • Lack of consensus on management has hindered effective patient care.

Purpose of the Study:

  • To summarize recent joint international guidelines on diagnosing and treating glucocorticoid-induced adrenal insufficiency.
  • To introduce a national blue corticosteroid treatment card for patient support and safety.
  • To prevent potentially fatal adrenal crises in patients receiving glucocorticoid therapy.

Main Methods:

  • Review and synthesis of joint guidelines from the European Society of Endocrinology and the Endocrine Society.
  • Description of the national blue corticosteroid treatment card initiative.
  • Identification of patient populations indicated for the treatment card (prednisolone >5 mg daily for >3-4 weeks).

Main Results:

  • New international guidelines offer consensus on diagnosis and treatment.
  • A national blue corticosteroid treatment card has been introduced for patient support.
  • The card targets patients on long-term, high-dose glucocorticoid therapy.

Conclusions:

  • Improved diagnosis and management of glucocorticoid-induced adrenal insufficiency are crucial.
  • The corticosteroid treatment card serves as a vital tool for patient safety.
  • Proactive measures are necessary to prevent adrenal crisis in at-risk populations.