Adrenal insufficiency: from concept to treatment

Authors

DOI:

https://doi.org/10.33448/rsd-v11i9.31901

Keywords:

Health education; Adrenal insufficiency; Diagnosis.

Abstract

Adrenal Insufficiency (AI) is a clinical condition resulting from the deficient synthesis of the hormone cortisol by the cortex of the glands located just above the kidneys. Cortisol performs several essential functions in the body, interfering with metabolism, blood pressure and inflammatory processes. AI can be classified as primary or secondary. The primary form occurs early on in the adrenal gland itself. Glandular inflammation, inherited enzyme deficits and infectious processes are the most common causes. The secondary form in this situation, the initial problem is in the hypothalamus or the pituitary gland, located at the base of the brain. Tumors in this portion or abrupt discontinuation of glucocorticoid therapy are the most frequently seen. The following article aimed to describe from concept to treatment of adrenal insufficiency. This is a narrative review of literature based on SciELO, MEDLINE, BVS, SBEM platforms, in the time frame of the last 5 years. There is a lot of information on the subject in the scientific literature. Possibly this underscores the importance of the topic, in which current data on the definition, classification, clinical picture, diagnosis and treatment of AI are made available in full. In view of the information collected, it can be clarified that AI is a syndrome with clinical implications that urge an early and differential diagnosis, investigation of the etiological cause and appropriate treatment according to the clinical condition of the patient and the form of presentation of AI.

References

Alexandraki, K.I. & Grossman A. (2019). Management of Hypopituitarism. J Clin Med., 8(12), 2153. doi:10.3390/jcm8122153

Alexandraki, K. I., & Kaltsas, G. A. (2022). Adrenal insufficiency and pregnancy. Current Opinion in Endocrinology, Diabetes, and Obesity, 29(3), 277–283. https://doi.org/10.1097/MED.0000000000000726

Alves, C., Robazzi, T. C. V. & Mendonça, M. (2008). Retirada da corticoterapia: recomendações para a prática clínica. Jornal de Pediatria, 84(3), 192-202. https://doi.org/10.2223/JPED.1773.

Bennett, G., Cussen, L., & O’Reilly, M. W. (2022). The role for long-term use of dehydroepiandrosterone in adrenal insufficiency. Current Opinion in Endocrinology, Diabetes, and Obesity, 29(3), 284–293. https://doi.org/10.1097/MED.0000000000000728

Bowden S.A., Connolly A. M., Kinnett K. & Zeitler P.S. (2019). Management of Adrenal Insufficiency Risk After Long-term Systemic Glucocorticoid Therapy in Duchenne Muscular Dystrophy: Clinical Practice Recommendations. J Neuromuscul Dis, 6(1), 31-41. doi:10.3233/JND-180346.

Caetano, J. D. S., Castilho, S. R. de, & Santos, V. dos. (2021). Perspective of pharmaceutical practice in adrenal insufficiency: An integrative review. Research, Society and Development, 10(7), e5610716197. https://doi.org/10.33448/rsd-v10i7.16197

Esslami, G. G., & Moienafshar, A. (2022). Neonatal bilateral adrenal hemorrhage and adrenal insufficiency accompanied by Subgaleal hematoma: a case report with brief review of literature. BMC Pediatrics, 22(1), 248. https://doi.org/10.1186/s12887-022-03314-1

Gupta, P., Sharma, R., & Jain, V. (2022). Adrenal hypoplasia congenita-hypogonadotropic hypogonadism syndrome due to NR0B1 gene mutations. Indian Journal of Pediatrics, 89(6), 587–590. https://doi.org/10.1007/s12098-021-04055-2

Grossman, A. B. ([s.d.]). Insuficiência adrenal secundária. Manuais MSD edição para profissionais. https://www.msdmanuals.com/pt-br/profissional/dist%C3%BArbios-end%C3%B3crinos-e-metab%C3%B3licos/dist%C3%BArbios-adrenais/insufici%C3%AAncia-adrenal-secund%C3%A1ria

Huecker, M.R., Bhutta, B.S., Dominique, E. & Bossuah, K. A. (2021). Insuficiência adrenal (nursing). Treasure Island (FL): StatPearls Publishing. Retrieved from https://fs53slaq3neykuquxervhfvj5a-adv7ofecxzh2qqi-www-ncbi-nlm-nih-gov.translate.goog/books/NBK568707/

Mendes, A. L. V., Gaspar, W. S., Madeira, I. R., Bordallo, A. P. N., Gilban, D. S., Borschiver, C. et al. (2017). Insuficiência adrenal primária causada por deleção no gene DAX1. Residência em Pediatria, 7(3):114-7. DOI: https://doi.org/10.25060/residpediatr-2017.v7n3-07 e

Menzies-Gow, A., Kreindler, J., Katial, R., & Gurnell, M. (2022). Adrenal insufficiency in patients taking benralizumab as corticosteroid sparing therapy - Authors’ reply. The Lancet. Respiratory Medicine, 10(1), e8. https://doi.org/10.1016/S2213-2600(21)00489-6

Morais, L. R. de, Abreu, C. A., Silva, G. G. L. da, Campos, I. C. de O., Maia, L. M. G., Silva, L. R., Berardo, M. M. de C., Silva, M. S., Oliveira, R. E. S., & Aquino, M. L. A. (2020). A importância da triagem neonatal como diagnóstico precoce da hiperplasia adrenal congênita. Brazilian Journal of Health Review, 3(4), 10814–10825. https://doi.org/10.34119/bjhrv3n4-339

Nieman, L. K. (2021). Patient education: Adrenal insufficiency (Addison's disease) (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/adrenal-insufficiency-addisons-disease-beyond-the-basics

Oprea, A., Bonnet, N., Pollé, O., & Lysy, P. A. (2019). Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency. Therapeutic advances in endocrinology and metabolism, 10. https://doi.org/10.1177/2042018818821294

Shah, K., Boyd, J. W., Broussard, J. R., Ginn, K., Rahmetulla, R., Hurst, K., & Goyal, R. K. (2022). Adrenocortical function in children with brain tumors and pediatric hematopoietic cell transplantation recipients. Journal of Pediatric Hematology/Oncology, 44(2), e469–e473. https://doi.org/10.1097/MPH.0000000000002220

Singhal, M., Sharma, S., Tom, N. B., Agarwal, M. K., & Mathur, A. (2022). A study of adrenal insufficiency in hemodynamically stable patients with cirrhosis. The Journal of the Association of Physicians of India, 70(4), 11–12. https://pesquisa.bvsalud.org/portal/resource/pt/mdl-35443330

Vieira, D. S. (2021, September 19). Diagnóstico e tratamento da insuficiência adrenal. Dra. Suzana Vieira. https://drasuzanavieira.med.br/2021/09/19/diagnostico-e-tratamento-da-insuficiencia-adrenal/

Published

10/07/2022

How to Cite

CARVALHO, L. do C. .; SILVA , M. de M. e .; REIS , O. G. dos .; SILVA , N. G. da .; MACHADO, D. O. Q. .; OLIVEIRA JUNIOR, V. D. de .; SILVA , L. da C.; MELO , A. M. de S. .; SILVA, S. C. M. .; SOLER, C. M. D. .; MENDES FILHO, E. B. . Adrenal insufficiency: from concept to treatment. Research, Society and Development, [S. l.], v. 11, n. 9, p. e29411931901, 2022. DOI: 10.33448/rsd-v11i9.31901. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/31901. Acesso em: 22 nov. 2024.

Issue

Section

Review Article