Contemporary Management of Adrenal Insufficiency: A Comprehensive Review of Diagnostic Strategies, Therapeutic Interventions, and Long-Term Monitoring
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Abstract
Adrenal insufficiency (AI) is a life-threatening endocrine disorder characterized by inadequate production or action of glucocorticoids, with or without deficiency in mineralocorticoids and adrenal androgens. The condition can be primary (due to adrenal gland dysfunction), secondary (due to pituitary dysfunction), or tertiary (due to hypothalamic dysfunction). The management of AI has evolved significantly over the past decade, with advancements in diagnostic modalities, glucocorticoid replacement therapies, and patient education. This article provides a comprehensive review of the current diagnostic approaches, including dynamic endocrine testing and imaging studies, as well as the latest therapeutic strategies, such as individualized glucocorticoid dosing, dual-release formulations, and the emerging role of circadian rhythm-based therapies. Additionally, the importance of patient education, self-management, and long-term monitoring to prevent adrenal crises and optimize quality of life is emphasized. The review also highlights the challenges in managing special populations, including pediatric patients, pregnant women, and those with concurrent comorbidities. By integrating the latest evidence-based practices, this article aims to guide clinicians in delivering optimal care for patients with adrenal insufficiency.
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References
I. Hahner S, Ross RJ, Arlt W, Bancos I, Burger-Stritt S, Torpy DJ, et al. Adrenal insufficiency. Nat Rev Dis Primers. 2021;7:19. doi: 10.1038/s41572-021-00252-7.
II. Husebye ES, Pearce SH, Krone NP, Kampe O. Adrenal insufficiency. Lancet. 2021;397:613–29. doi: 10.1016/S0140-6736(21)00136-7.
III. Barthel A, Benker G, Berens K, Diederich S, Manfras B, Gruber M, et al. An update on Addison’s disease. Exp Clin Endocrinol Diabetes. 2019;127:165–75. doi: 10.1055/a-0804-2715.
IV. Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:364–89. doi: 10.1210/jc.2015-1710.
V. Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R, et al. Hormonal replacement in hypopituitarism in adults: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:3888–921. doi: 10.1210/jc.2016-2118.
VI. Prete A, Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ. 2021;374:n1380. doi: 10.1136/bmj.n1380.
VII. Papierska L, Rabijewski M. Delay in diagnosis of adrenal insufficiency is a frequent cause of adrenal crisis. Int J Endocrinol. 2013;2013:482370. doi: 10.1155/2013/482370.
VIII. Arlt W, Callies F, van Vlijmen JC, Koehler I, Reincke M, Bidlingmaier M, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med. 1999;341:1013–20. doi: 10.1056/NEJM199909303411401.
IX. Diederich S, Franzen NF, Bahr V, Oelkers W. Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocrinol. 2003;148:609–17.
doi: 10.1530/eje.0.1480609.
X. Garrahy A, Thompson CJ. Hyponatremia and glucocorticoid deficiency. Front Horm Res. 2019;52:80–92. doi: 10.1159/000493239.
XI. Benner BJ, Alsma J, Feelders RA. Hyponatraemia and hyperpigmentation in primary adrenal insufficiency. BMJ Case Rep. 2019;12:e227200. doi: 10.1136/bcr-2018-227200.
XII. Mohamed F, Raal FJ. Hyperpigmentation from Addison’s disease. N Engl J Med. 2021;384:1752. doi: 10.1056/NEJMicm2018221.
XIII. Abdel-Malek ZA, Knittel J, Kadekaro AL, Swope VB, Starner R. The melanocortin 1 receptor and the UV response of human melanocytes: a shift in paradigm. Photochem Photobiol. 2008;84:501–8. doi: 10.1111/j.1751-1097.2008.00294.x.
XIV. Grossman AB. Clinical review: the diagnosis and management of central hypoadrenalism. J Clin Endocrinol Metab. 2010;95:4855–63. doi: 10.1210/jc.2010-0982.
XV. Kumar R, Carr P, Wassif W. Diagnostic performance of morning serum cortisol as an alternative to short synacthen test for the assessment of adrenal reserve; a retrospective study. Postgrad Med J. 2022;98:113–8. doi: 10.1136/postgradmedj-2020-138514.
XVI. Charoensri S, Chailurkit L, Muntham D, Bunnag P. Serum dehydroepiandrosterone sulfate in assessing the integrity of the hypothalamic-pituitary-adrenal axis. J Clin Transl Endocrinol. 2017;7:42–6. doi: 10.1016/j.jcte.2017.01.001.