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二次上腺危机的诊断和管理

Luciana Martel-Duguech¹, Jonathan Poirier¹, Isabelle Bourdeau¹

¹Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CHUM), 900 Saint-Denis Street, Montréal, QC H2X 0A9, Québec, Canada.

Reviews in endocrine & metabolic disorders

|February 27, 2024

概括

上腺危机 (AC),一种危及生命的急性上腺功能衰竭 (AI) 状况,日益普遍. 及时诊断和关于葡萄糖皮质激素管理的教育对于预防风险患者的AC至关重要.

科学领域:

内分泌学在内分泌学.
内部医学内部医学
医学教育医学教育

背景情况:

上腺危机 (AC) 是急性上腺衰竭 (AI) 的严重表现,影响患有初级或二级/三级/阴性AI的患者.
交流源于HPA轴的功能障碍,导致多器官衰竭和未经治疗的潜在死亡.
在二级AI (SAI),三级AI (TAI) 和阳性AI (IAI) 中,AC的患病率增加与外源性类固醇使用,免疫检查点抑制剂和阿片类止痛药有关.

研究的目的:

审查上腺危机的病理生理学,诱发因素,诊断挑战和管理.
为了突出SAI,TAI和IAI中AC日益增长的发病率.
强调预防教育和早期诊断的重要性.

主要方法:

关于上腺危机病理生理学,临床表现和治疗的文献综述.
分析导致AC患病率上升的因素.
讨论诊断障碍和治疗策略.

主要成果:

由于HPA轴的干扰,在压力期间,AC的结果是葡萄糖皮质激素反应不足.
常见的触发因素包括感染,手术,压力和药物变化.
延迟诊断是常见的,增加了AC风险.
有效的治疗包括静脉注射皮和盐水复苏.

结论:

AC需要紧急的皮和液体的管理.
预防策略至关重要,包括对病假规则的患者教育,以及自行服用皮.
医疗协会和患者团体之间需要加强合作,以改善对患有二次AI风险的患者的预防教育.

关键词:

上腺危机是一个危机.诊断诊断诊断诊断诊断葡萄糖皮质醇诱导的上腺功能不全催产腺上腺功能不全引起的Iatrogenic 预防预防预防二次上腺功能不充分症第三级上腺功能不充分治疗疗法治疗疗法

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