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大人の腎上腺不全: レビュー
Anand Vaidya1, James Findling2, Irina Bancos3,4
1Center for Adrenal Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA
|June 16, 2025
まとめ
グルココルチコイド誘発の副腎不全は,まれな第一種および第二種とは異なり,一般的です. 診断には朝のコルチゾール,コルチトロピン,DHEAS検査が含まれており,治療にはグルココルチコイドと危機予防教育が含まれます.
科学分野:
- 内分泌学
- 内科 医学
背景:
- 腎上腺不全,コルチゾール欠乏症候群は,主,二次,またはグルココルチコイド誘発として現れます.
- 主要および二次的な形態は稀ですが,グルココルチコイド誘発の腎上腺不全は一般的です.
研究 の 目的:
- 副腎不全の原因,発現,診断,治療について概要を述べる.
- グルココルチコイド誘発性副腎不全の共通点と,より稀な形態との区別を強調する.
主な方法:
- 主要および次要の副腎不全の自己免疫的,先天的,薬学的,感染症的および外科的要因を含む原因のレビュー.
- 診断方法の説明:早朝の血清コルチゾール,コルチトロピン,およびデヒドロエピアンドロステロン硫酸 (DHEAS) の測定,曖昧な症例のコルチトロピン刺激検査.
- 治療戦略の概要:グルココルチコイド補給,主要な症例のミネラルコルチコイド補給,急性疾患と腎上腺危機の管理に関する患者の教育.
主要な成果:
- 疲労,吐き気,嘔吐,食欲低下,体重減少などの非特異的な症状は,腎上腺機能不全の患者で一般的です.
- 診断基準は,プライマリ (低コルチゾール,高コルチトロピン,低DHEAS) と二次/グルココルチコイド誘発 (低/中間コルチゾール,低/低正常のコルチトロピンおよびDHEAS) を区別する.
- 腎上腺危機は生命を脅かす合併症であり,すぐに認識し,注射可能なグルココルチコイドで治療する必要があります.
結論:
- グルココルチコイドによる腎上腺機能不全は,特にグルココルチコイドの離脱後に,臨床的疑惑を必要とする一般的な状態です.
- 正確な診断は特定のホルモンの測定に依拠し,副腎不全の種類を区別します.
- 総合的な管理には,グルココルチコイド補充,必要に応じてミネラルコルチコイド,腎上腺危機を防ぐために重要な患者の教育が含まれています.
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