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成年人的上腺功能缺陷:一篇综述
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
概括
与罕见的初级和次级形式不同,葡萄糖皮质激素诱导的上腺功能不全是常见的. 诊断包括早晨皮质醇,皮质热素和DHEAS测试,治疗包括葡萄皮质类药物和危机预防教育.
科学领域:
- 内分泌学
- 内部医学
背景情况:
- 上腺功能不充分,一种皮质醇缺乏综合征,呈现为主要,次要或葡萄糖皮质醇诱导.
- 虽然主要和次要形式很少见,但常见的是葡萄皮质激素诱导的上腺功能不全.
研究的目的:
- 概述上腺功能衰竭的原因,表现,诊断和治疗.
- 强调糖皮质激素诱导的上腺功能衰竭的普遍性及其与较罕见的形式的区别.
主要方法:
- 主要和次要上腺功能衰竭的原因包括自身免疫,先天性,药物学,传染病和手术因素的审查.
- 诊断方法描述:早晨测量血清皮质醇,皮质激素和脱胺硫酸盐 (DHEAS),对模糊病例进行皮质激素刺激测试.
- 治疗策略概要:葡萄糖皮质激素补充剂,矿物质皮质激素补充剂用于初级病例,以及对治疗急性疾病和上腺危机的患者教育.
主要成果:
- 患有上腺功能不足的患者常有疲劳,恶心,吐,厌食症和体重减轻等非特异性症状.
- 诊断标准区分初级 (低皮质醇,高皮质激素,低DHEAS) 和二次/糖皮质激素诱导 (低/中等皮质醇,低/低正常皮质激素和DHEAS).
- 上腺危机是一种危及生命的并发症,需要迅速识别并使用可注射的皮质糖类药物治疗.
结论:
- 葡萄糖皮质类药物诱导的上腺功能衰竭是一种常见的疾病,需要临床怀疑,特别是在葡萄糖皮质类药物停用后.
- 准确的诊断依赖于特定的荷尔蒙测量,区分上腺功能缺陷的类型.
- 综合治疗包括葡萄糖皮质激素替代剂,必要时矿物质皮质激素,以及预防上腺危机的关键患者教育.
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