患有性综合征的儿童的类固醇诱导的上腺功能不全:系统性审查
Kalliopi Vardaki1, Ilianna Maniadaki2, Emmanouil Galanakis2
1Departments of Pediatrics and Nephrology, School of Medicine, University of Crete, Heraklion, Greece. pvardaki@gmail.com.
Pediatric nephrology (Berlin, Germany)
|February 18, 2026
概括
类固醇诱导的上腺功能衰竭 (AI) 是患有异常性性综合征 (NS) 的儿童常见的并发症. 早期查和标准化检测对于管理这种未被认可的疾病至关重要,特别是在高风险患者中.
科学领域:
- 儿科内分泌学 儿科内分泌学
- 腎臟病學 (nephrology) 是一種醫學.
- 药理学 药理学是指药理学的学科.
背景情况:
- 异形性性综合征 (NS) 是儿童中最常见的球性疾病.
- 皮质类固醇是NS的主要治疗方法,可以抑制下丘脑-垂体-上腺 (HPA) 轴,导致上腺功能不充分 (AI).
- 儿童NS中类固醇诱导的AI的患病率和临床影响仍然不太清楚.
研究的目的:
- 系统地评估患病率,诊断方法,风险因素和类固醇诱导的AI在NS儿童中的临床影响.
- 综合当前关于儿童NS患者用皮质类固醇治疗的AI的证据.
- 识别知识缺口和未来研究领域.
主要方法:
- 在2025年10月3日之前,对Medline和参考列表进行系统的文献搜索.
- 包括13项英语研究,涉及516名儿科患者评估上腺功能或AI.
- 排除案例报告,摘要和评论;遵守PRISMA 2020指南;由于异质性而导致叙事综合.
主要成果:
- 报告的AI患病率差异很大 (5.9%92.9%),受诊断测试和时间的影响;2小时ACTH刺激测试显示出最高的收益率.
- 对AI的定义和皮质醇切断值在各个研究中都不一致.
- 在患有经常复发/类固醇依赖性NS,长期使用类固醇的儿童中,AI更频繁,并且与复发风险增加有关,特别是在感染期间.
结论:
- 类固醇诱导的AI是儿科NS中常见的,潜在的未被认可的并发症,特别是在高风险组中.
- 方法的异质性,诊断标准的缺乏共识,以及有限的后续数据阻碍了准确的流行率估计.
- 非常需要标准化检测方案和临床指导方针;在高危儿童中,应考虑查和皮质醇替代.
相关概念视频
01:24Nephrotic Syndrome I : Introduction
712
Nephrotic Syndrome is a chronic kidney disorder defined by clinical findings such as severe proteinuria, hypoalbuminemia, hyperlipidemia, and edema. These symptoms result from damage to the glomeruli, the kidney’s filtering units, increasing their permeability to proteins.Definition and Meaning:Proteinuria, defined as the loss of more than 3.5 grams of protein per day in adults, is a crucial feature of nephrotic syndrome. This condition is often accompanied by edema, the accumulation of...
712
01:26Nephrotic Syndrome II : Assessment and Medical Management
263
IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document...
263
01:27Adrenal Gland Disorders
3.4K
Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
3.4K
01:24Nephrotic Syndrome III : Nursing Management
363
Nursing management for nephrotic syndrome adapts as the disease progresses, with strategies evolving to address advancing symptoms and complications.Early-Stage Management In the early stages, nursing interventions for nephrotic syndrome resemble those used in managing acute glomerulonephritis, focusing on symptom monitoring, fluid balance, and managing mild to moderate edema.Vital Signs: Regularly monitor blood pressure, pulse, respiratory rate, and temperature to promptly identify...
363
01:29Acute Kidney Injury II: Pathophysiology
1.3K
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
1.3K
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
289
In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
289