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Addison Disease HELP
Based on 550 articles since 2006

These are the 550 published articles about Addison Disease that originated from Worldwide during 2006-2015.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. 2014

Husebye, E S / Allolio, B / Arlt, W / Badenhoop, K / Bensing, S / Betterle, C / Falorni, A / Gan, E H / Hulting, A-L / Kasperlik-Zaluska, A / Kämpe, O / Løvås, K / Meyer, G / Pearce, S H. ·Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway. · ·J Intern Med · Pubmed #24330030.

ABSTRACT: Primary adrenal insufficiency (PAI), or Addison's disease, is a rare, potentially deadly, but treatable disease. Most cases of PAI are caused by autoimmune destruction of the adrenal cortex. Consequently, patients with PAI are at higher risk of developing other autoimmune diseases. The diagnosis of PAI is often delayed by many months, and most patients present with symptoms of acute adrenal insufficiency. Because PAI is rare, even medical specialists in this therapeutic area rarely manage more than a few patients. Currently, the procedures for diagnosis, treatment and follow-up of this rare disease vary greatly within Europe. The common autoimmune form of PAI is characterized by the presence of 21-hydroxylase autoantibodies; other causes should be sought if no autoantibodies are detected. Acute adrenal crisis is a life-threatening condition that requires immediate treatment. Standard replacement therapy consists of multiple daily doses of hydrocortisone or cortisone acetate combined with fludrocortisone. Annual follow-up by an endocrinologist is recommended with the focus on optimization of replacement therapy and detection of new autoimmune diseases. Patient education to enable self-adjustment of dosages of replacement therapy and crisis prevention is particularly important in this disease. The authors of this document have collaborated within an EU project (Euadrenal) to study the pathogenesis, describe the natural course and improve the treatment for Addison's disease. Based on a synthesis of this research, the available literature, and the views and experiences of the consortium's investigators and key experts, we now attempt to provide a European Expert Consensus Statement for diagnosis, treatment and follow-up.

2 Editorial Adrenal insufficiency with special reference to tuberculosis. 2014

Parameswaran, V. · ·Indian J Tuberc · Pubmed #25509930.

ABSTRACT: -- No abstract --

3 Editorial Clinicians sometimes miss cases of latent primary adrenal insufficiency involving stress-related health changes. 2014

Nishikawa, Tetsuo / Omura, Masao / Saito, Jun / Matsuzawa, Yoko. ·Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Japan. · ·Intern Med · Pubmed #24492682.

ABSTRACT: -- No abstract --

4 Editorial How to avoid precipitating an acute adrenal crisis. 2012

Wass, John A H / Arlt, Wiebke. · ·BMJ · Pubmed #23048013.

ABSTRACT: -- No abstract --

5 Editorial Compounding risk for hypoglycemia: type 1 diabetes and Addison's disease. 2012

Barker, Jennifer M. · ·Diabetes Technol Ther · Pubmed #22506859.

ABSTRACT: -- No abstract --

6 Editorial [Full-blown diseases]. 2009

Scriba, P C. · ·Dtsch Med Wochenschr · Pubmed #19746327.

ABSTRACT: -- No abstract --

7 Editorial Glucocorticoid replacement therapy in patients with Addison's disease. 2007

Kyriazopoulou, Venetsana. · ·Expert Opin Pharmacother · Pubmed #17425469.

ABSTRACT: One hundred and fifty years ago, Thomas Addison published his classic paper on the 'Constitutional and Local Effects of Disease of the Supra-renal Capsules', in which he described 11 patients with the disorder that would come to bear his name. Adrenal insufficiency is a rare disease, but its prevalence is increasing. The most frequent causes of adrenal insufficiency in western countries are autoimmune adrenalitis, but other causes include, tuberculosis systemic fungal infections, AIDS, metastatic carcinoma and isolated glucocorticoid deficiency. It is clear that autoimmunity precedes overt Addison's disease by years, as in many autoimmune endocrine disorders. Adrenocortical function is lost over a period of years as it progresses to overt Addison's disease. This editorial discusses the controversial glucocorticoid replacement therapy in patients with Addison's disease, and aims to provide a good review of literature and suggested guidelines for appropriate treatment of this disease.

8 Editorial Adrenocortical insufficiency: an early step in the pathogenesis of severe acute pancreatitis and development of necrosis? Do we have a new treatment option? 2006

Marx, Christian. · ·Crit Care Med · Pubmed #16550087.

ABSTRACT: -- No abstract --

9 Review [Autoimmune diseases in type 1A diabetes mellitus]. 2015

Ferreira-Hermosillo, Aldo / Molina-Ayala, Mario Antonio. · ·Rev Med Chil · Pubmed #26436934.

ABSTRACT: Type 1A diabetes (DM1A) is an autoimmune disease that comprises 10% of patients with diabetes mellitus. Its frequency is gradually increasing in countries like Mexico. Patients with DM1A commonly have hypothyroidism, Addison disease, celiac disease and less common diseases such as polyglandular syndrome. These diseases are related to susceptibility genes such as HLA, CTLA-4 and PTPN22, which induce central and peripheral immunologic tolerance. This review article emphasizes the importance of searching other autoimmune diseases in patients with DM1A, to improve their prognosis and quality of life.

10 Review An overview of the nursing issues involved in caring for a child with adrenal insufficiency. 2015

Moloney, Sinéad / Murphy, Nuala / Collin, Jacqueline. ·Temple Street Children's University Hospital, Dublin. · King's College London. ·Nurs Child Young People · Pubmed #26360180.

ABSTRACT: Adrenal insufficiency is an endocrine condition defined as the inadequate production or action of glucocorticoids, principally a steroid hormone called cortisol. While rare in childhood, it carries the risk of adrenal crisis in the event of a child becoming unwell as a result of intercurrent illness, injury or surgery. Children's nurses must be vigilant in caring for a child with adrenal insufficiency and have a clear understanding and awareness of the principles of emergency management at home and in hospital.

11 Review Clinical Perspective: What Do Addison and Cushing Tell Us About Glucocorticoid Action? 2015

Harris, Charles. ·Division of Endocrinology, Metabolism and Lipid Research, Department of Internal Medicine, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8127, St. Louis, MO, 63110, USA, caharris@dom.wustl.edu. ·Adv Exp Med Biol · Pubmed #26215991.

ABSTRACT: This chapter is distinct from the others in its clinical subject matter. I will attempt to outline the major points of interest in glucocorticoids clinically. To aid the illustration in the evaluation of a patient with Cushing disease I have created a case study.

12 Review Focus on vitamin D and the adrenal gland. 2015

Muscogiuri, G / Altieri, B / Penna-Martinez, M / Badenhoop, K. ·Department of Clinical Medicine and Surgery, Section of Endocrinology, University "Federico II", Naples, Italy. · Institute of Medical Pathology, Division of Endocrinology and Metabolic Disease, Catholic University, Rome, Italy. · Division of Endocrinology & Diabetes, Department of Medicine 1, Center of Internal Medicine, University Hospital, Goethe-University, Frankfurt am Main, Germany. ·Horm Metab Res · Pubmed #25723858.

ABSTRACT: The main role of vitamin D is to maintain calcium and phosphorus homeostasis, thus preserving bone health. However, recent evidences have demonstrated that vitamin D may also play a role in a variety of nonskeletal disorders such as endocrine diseases and in particular type 1 diabetes, type 2 diabetes, adrenal diseases, and the polycystic ovary syndrome. Despite controversial results on an association of low vitamin D levels with cortisol and aldosterone overproduction, encouraging in vitro findings have been reported on vitamin D effects in adrenocortical cancer cells. The focus of this review is the role of vitamin D in adrenal diseases and the results of vitamin D supplementation studies in patients. Although many studies support a beneficial role of vitamin D in adrenal disease, randomized controlled trials and mechanistic studies are required to provide more insight into the efficacy and safety of vitamin D as a therapeutic tool.

13 Review Embryological and molecular development of the adrenal glands. 2015

Ross, Ian L / Louw, Graham J. ·Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, Republic of South Africa. · ·Clin Anat · Pubmed #25255746.

ABSTRACT: In this mini review, the embryological and functional development of the adrenal glands is presented from a molecular perspective. While acknowledging that this is a highly complex series of events, the processes are described in simple and broad strokes in a single text for the reader who is interested in this field but is not an active researcher. The origin of the adrenal glands is in the mesodermal ridge as early as the fourth week of gestation. Between the eighth and ninth weeks of gestation, the adrenal glands are encapsulated and this results in the presence of a distinct organ. There have been great strides in deciphering the very complicated molecular aspects of adrenal gland development in which multiple transcription factors have been identified, directing the adrenogonadal primordium into the adrenal cortex, kidney, or bipotential gonad. Adrenocorticotrophic hormone is critical for early development of the hypothalamic-pituitary adrenal axis. Several mutations in transcription factors, responsible for normal adrenal gland development have been found to induce the familial syndrome of congenital adrenal hypoplasia or neoplasia.

14 Review Management of hypertension and heart failure in patients with Addison's disease. 2015

Inder, Warrick J / Meyer, Caroline / Hunt, Penny J. ·Department of Diabetes and Endocrinology, Princess Alexandra Hospital and University of Queensland, Brisbane, Qld, Australia. · Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Vic., Australia. · Department of Endocrinology, Christchurch Hospital and University of Otago, Christchurch, New Zealand. ·Clin Endocrinol (Oxf) · Pubmed #25138826.

ABSTRACT: Addison's disease may be complicated by hypertension and less commonly by heart failure. We review the pathophysiology of the renin-angiotensin-aldosterone axis in Addison's disease and how this is altered in the setting of hypertension and heart failure. An essential first step in management in both conditions is optimizing glucocorticoid replacement and considering dose reduction if excessive. Following this, if a patient with Addison's disease remains hypertensive, the fludrocortisone dose should be reviewed and reduced if there are clinical and/or biochemical signs of mineralocorticoid excess. In the absence of such signs, where the renin is towards the upper end of the normal range or elevated, an angiotensin II (AII) receptor antagonist or angiotensin converting enzyme (ACE) inhibitor is the treatment of choice, and the fludrocortisone dose should remain unchanged. Dihydropyridine calcium channel blockers are clinically useful as second line agents, but diuretics should be avoided. In the setting of heart failure, there is an increase in total body sodium and water; therefore, it is appropriate to reduce and rarely consider ceasing the fludrocortisone. Loop diuretics may be used, but not aldosterone antagonists such as spironolactone or eplerenone. Standard treatment with ACE inhibitors, or as an alternative, AII receptor antagonists, are appropriate. Measurements of renin are no longer helpful in heart failure to determine the volume status but plasma levels of brain natriuretic peptide (BNP/proBNP) may help guide therapy.

15 Review Anaemia, a common but often unrecognized risk in diabetic patients: a review. 2015

Angelousi, A / Larger, E. ·Service de diabétologie, GH Cochin-Hôtel Dieu, Paris, France; 6, rue Andromachis, 12135 Athens, Greece. · Service de diabétologie, GH Cochin-Hôtel Dieu, Paris, France; Université Paris-René-Descartes, Paris, France. Electronic address: etienne.larger@cch.aphp.fr. ·Diabetes Metab · Pubmed #25043174.

ABSTRACT: Anaemia in patients with diabetes, both type 1 and type 2, is a frequent clinical finding. The mechanisms of anaemia are multifactorial and often not very well understood. Iatrogenic causes, including oral antidiabetic drugs, ACE inhibitors and ARBs, and renal insufficiency are the major causes of anaemia in patients with type 2 diabetes. In patients with type 1, the cause is often an associated autoimmune disease, and screening for autoimmune gastritis, pernicious anaemia, Hashimoto's thyroiditis, coeliac disease and Addison's disease is recommended. Other rare causes - including G6PD deficiency, microangiopathic haemolytic anaemia and thiamine-responsive megaloblastic anaemia - should be suspected in young patients or when the classical causes are excluded. Early detection and recognition of the cause(s) of anaemia in patients with diabetes could help to prevent other clinical manifestations as well as the complications of diabetes.

16 Review Health-related quality of life in primary and secondary adrenal insufficiency. 2014

Aulinas, Anna / Webb, Susan M. ·Endocrinology/Medicine Departments, Sant Pau Biomedical Research Institute, Hospital de Sant Pau, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret, 167, 08025-Barcelona, Spain. · ·Expert Rev Pharmacoecon Outcomes Res · Pubmed #25252879.

ABSTRACT: Adrenal insufficiency (AI) is characterized by a deficient production of glucocorticoids with or without associated mineral corticoid and/or adrenal androgen deficiencies. Despite the low prevalence of AI, its impact on the affected patient is very high, and can be life-threatening disease if not adequately treated. Several glucocorticoid treatment regimens are available, but none is capable of perfectly imitating the cortisol circadian rhythm. Cortisol rhythmicity and treatment of other possible concomitant conditions often associated (e.g., autoimmune disorders and panhypopituitarism) are essential to improve outcome of AI. Morbidity often present in treated AI include an unhealthy metabolic profile, bad quality of sleep, infertility, sexual dysfunction and worse health-related quality of life. This review focuses on psychological morbidity and impaired quality of life in patients with primary or secondary AI of any origin, including a special section devoted to congenital adrenal hyperplasia.

17 Review X-linked adrenoleukodystrophy: pathogenesis and treatment. 2014

Engelen, Marc / Kemp, Stephan / Poll-The, Bwee-Tien. ·Department of Pediatric Neurology/Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, 1100 DD, The Netherlands, m.engelen@amc.uva.nl. · ·Curr Neurol Neurosci Rep · Pubmed #25115486.

ABSTRACT: X-linked adrenoleukodystrophy (X-ALD) is a puzzling inborn error of metabolism with a strikingly heterogeneous clinical spectrum. All patients have mutations in the ABCD1 gene and accumulate very long chain fatty acids in all tissues. Virtually all male X-ALD patients develop adrenocortical insufficiency in childhood and progressive myelopathy and peripheral neuropathy in adulthood. A subset of male patients, however, develops a fatal cerebral demyelinating disease, cerebral adrenoleukodystrophy. Female patients also develop progressive myelopathy and peripheral neuropathy, but generally at a later age than males. They only very rarely develop adrenocortical insufficiency or cerebral adrenoleukodystrophy. This review proposes to simplify the classification of the clinical spectrum of X-ALD and reviews the largely unresolved pathophysiological mechanisms and the current treatment options.

18 Review Psychological morbidity and impaired quality of life in patients with stable treatment for primary adrenal insufficiency: cross-sectional study and review of the literature. 2014

Tiemensma, Jitske / Andela, Cornelie D / Kaptein, Ad A / Romijn, Johannes A / van der Mast, Roos C / Biermasz, Nienke R / Pereira, Alberto M. ·Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. · Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands c.d.andela@lumc.nl. · Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. ·Eur J Endocrinol · Pubmed #24801589.

ABSTRACT: CONTEXT: A high prevalence of psychological morbidity and maladaptive personality as well as impaired quality of life (QoL) is observed in patients with and without hydrocortisone dependency following (cured) Cushing's syndrome. However, it is currently unclear whether a similar pattern is present in patients with chronic glucocorticoid replacement for primary adrenal insufficiency (PAI). OBJECTIVE: To evaluate psychological functioning, personality traits, and QoL in patients with PAI. DESIGN AND SUBJECTS: A cross-sectional study including 54 patients with stable treatment for PAI and 54 healthy matched controls. Both patients and controls completed questionnaires on psychological functioning (Apathy Scale, Irritability Scale, Mood and Anxiety Symptoms Questionnaire short form, and Hospital Anxiety and Depression Scale), personality traits (Dimensional Assessment of Personality Pathology short form), and QoL (Multidimensional Fatigue Inventory, Short Form 36, EuroQoL-5D, Nottingham Health Profile, and Physical Symptom Checklist). RESULTS: Patients with PAI suffered from more psychological morbidity (i.e. irritability and somatic arousal) and QoL impairments compared with controls (all P<0.01). There were no differences regarding maladaptive personality traits between patients and controls. However, there was a strong and consistent positive association between the daily hydrocortisone dose and prevalence of maladaptive personality traits (i.e. identity problems, cognitive distortion, compulsivity, restricted expression, callousness, oppositionality, rejection, conduct problems, social avoidance, narcissism, and insecure attachment, all P<0.05). There was also a strong relation between the mean daily hydrocortisone dose and both psychological morbidity (i.e. depression, P<0.05) and QoL impairments (i.e. general health perception, several measures of physical functioning, and vitality, all P<0.05). CONCLUSION: Patients on stable glucocorticoid replacement therapy for PAI report psychological morbidity and impaired QoL. Psychological morbidity, impaired QoL, and maladaptive personality traits were all associated with higher dosages of hydrocortisone.

19 Review Current and emerging therapies for Addison's disease. 2014

Napier, Catherine / Pearce, Simon H S. ·Institute of Genetic Medicine, Newcastle University, and Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK. · ·Curr Opin Endocrinol Diabetes Obes · Pubmed #24755997.

ABSTRACT: PURPOSE OF REVIEW: The purpose of this article is to review the current therapy of Addison's disease and to highlight recent developments in this field. RECENT FINDINGS: Conventional steroid replacement for Addison's disease consists of twice or three-times daily oral hydrocortisone and once-daily fludrocortisone; however, new treatment modalities such as modified-released hydrocortisone and continuous subcutaneous hydrocortisone infusion have recently been developed. These offer the potential for closer simulation of the physiological serum cortisol rhythm. Two studies have also looked at modifying the natural history of adrenal failure using adrenocorticotropic hormone (ACTH) stimulation and immunomodulatory therapies, leading to the concept of residual adrenal function in some Addison's disease patients. SUMMARY: Following more than 60 years with no significant innovation in the management of Addison's disease, these new approaches hold promise for improved patient health and better quality of life in the future.

20 Review Electrochemical sensing of cortisol: a recent update. 2014

Singh, Aparajita / Kaushik, Ajeet / Kumar, Rajesh / Nair, Madhavan / Bhansali, Shekhar. ·BioMEMS and Microsystems Laboratory, Department of Electrical and Computer Engineering, Florida International University, Miami, FL, 33174, USA. · ·Appl Biochem Biotechnol · Pubmed #24723204.

ABSTRACT: Psychological stress caused by everyday lifestyle contributes to health disparities experienced by individuals. It affects many biomarkers, but cortisol - "a steroid hormone" - is known as a potential biomarker for psychological stress detection. Abnormal levels of cortisol are indicative of conditions such as Cushing's syndrome Addison's disease, adrenal insufficiencies and more recently post-traumatic stress disorder (PTSD). Chromatographic techniques, which are traditionally used to detect cortisol, are a complex system requiring multistep extraction/purification. This limits its application for point-of-care (POC) detection of cortisol. However, electrochemical immunosensing of cortisol is a recent advancement towards POC application. This review highlights simple, low-cost, and label-free electrochemical immunosensing platforms which have been developed recently for sensitive and selective detection of cortisol in bio-fluids. Electrochemical detection is utilized for the detection of cortisol using Anti-Cortisol antibodies (Anti-Cab) covalently immobilized on nanostructures, such as self-assembled monolayer (SAM) and polymer composite, for POC integration of sensors. The observed information can be used as a prototype to understand behavioral changes in humans such as farmers and firefighters. Keeping the future directions and challenges in mind, the focus of the BioMEMS and Microsystems Research Group at Florida International University is on development of POC devices for immunosensing, integration of these devices with microfluidics, cross validation with existing technologies, and analysis of real sample.

21 Review Diagnosis and classification of Addison's disease (autoimmune adrenalitis). 2014

Brandão Neto, Rodrigo Antonio / de Carvalho, Jozélio Freire. ·Emergency Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. · Rheumatology Division, Aliança Medical Center, Salvador, Bahia, Brazil. Electronic address: rodneto@gmail.com. ·Autoimmun Rev · Pubmed #24424183.

ABSTRACT: Autoimmune adrenalitis, or autoimmune Addison disease (AAD), is the most prevalent cause of primary adrenal insufficiency in the developed world. AAD is rare and can easily be misdiagnosed as other conditions. The diagnosis depends on demonstrating inappropriately low cortisol production and the presence of high titers of adrenal cortex autoantibodies (ACAs), along with excluding other causes of adrenal failure using other tests as necessary. The treatment corticosteroid replacement, and the prognosis following the treatment is the same as the normal population. Spontaneous recovery of adrenal function has been described but is rare.

22 Review Autoimmune polyendocrine syndromes. 2014

Cutolo, Maurizio. ·Research Laboratories and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova Italy, Viale Benedetto XV, 6, 16132 Genova Italy. Electronic address: mcutolo@unige.it. ·Autoimmun Rev · Pubmed #24055063.

ABSTRACT: Autoimmune polyendocrine syndromes (APS), also called polyglandular autoimmune syndromes (PGAS), are a heterogeneous group of rare diseases characterized by autoimmune activity against more than one endocrine organs, although non-endocrine organs can be affected. The two major autoimmune polyendocrine syndromes, (type1-type2/APS-1 and APS-2), both have Addison's disease as a prominent component. Further autoimmune polyendocrine syndromes include APS3 and APS4. The major autoimmune polyendocrine syndromes have a strong genetic component with the type 2 syndrome occurring in multiple generations and the type I syndrome in siblings. It is well recognized that more than 20years may elapse between the onset on one endocrinopathy and the diagnosis of the next, for example, almost 40-50% of subjects with Addison's disease will develop an associated endocrinopathy. The discovery of the polyendocrine autoimmune syndromes offered the possibility to understand autoimmune disorders with particular interest for type 1A diabetes and the neuroendocrine immunology (NEI) is further contributing to understand the links.

23 Review Adrenal diseases during pregnancy: pathophysiology, diagnosis and management strategies. 2014

Kamoun, Mahdi / Mnif, Mouna F / Charfi, Nadia / Kacem, Faten H / Naceur, Basma B / Mnif, Fatma / Dammak, Mohamed / Rekik, Nabila / Abid, Mohamed. ·Endocrinology Department, Hedi Chaker Hospital, Sfax, Tunisia. · ·Am J Med Sci · Pubmed #23514671.

ABSTRACT: : Adrenal diseases--including disorders such as Cushing's syndrome, Addison's disease, pheochromocytoma, primary hyperaldosteronism and congenital adrenal hyperplasia--are relatively rare in pregnancy, but a timely diagnosis and proper treatment are critical because these disorders can cause maternal and fetal morbidity and mortality. Making the diagnosis of adrenal disorders in pregnancy is challenging as symptoms associated with pregnancy are also seen in adrenal diseases. In addition, pregnancy is marked by several endocrine changes, including activation of the renin-angiotensin-aldosterone system and the hypothalamic-pituitary-adrenal axis. The aim of this article was to review the pathophysiology, clinical manifestation, diagnosis and management of various adrenal disorders during pregnancy.

24 Review Determination of cortisol in serum, saliva and urine. 2013

Turpeinen, Ursula / Hämäläinen, Esa. ·HUSLAB, Laboratory of Women's Clinic, Haartmaninkatu 2, 00290 Helsinki, Finland. Electronic address: ursula.turpeinen@hus.fi. · ·Best Pract Res Clin Endocrinol Metab · Pubmed #24275191.

ABSTRACT: Cortisol is quantitatively the major glucocorticoid product of the adrenal cortex. The main reason to measure cortisol is to diagnose human diseases characterised by deficiency of adrenal steroid excretion in Addison's disease or overproduction in Cushing's syndrome (CS). In both cases a sensitive, accurate and reproducible assay of cortisol is required. Several methods have been described for the quantitative measurement of cortisol in both serum and urine. The most widely used methods in routine clinical laboratories are immunoassays (IA) and enzyme immunoassays (EIA), luminescence and fluorescence assays, which are available in numerous commercial kits and on automated platforms. However, there remains a number of problems in the so-called direct immunoassays if extraction and prepurification are not carried out before the assay. Recently, more specific chromatographic methods have been introduced, such as high pressure liquid chromatographic (HPLC) or liquid chromatography tandem mass spectrometric assays (LC-MS/MS). The high specificity especially of LC-MS/MS facilitates reliable measurement of cortisol both in plasma, urine and saliva samples.

25 Review Therapy of endocrine disease: Perspectives on the management of adrenal insufficiency: clinical insights from across Europe. 2013

Grossman, Ashley / Johannsson, Gudmundur / Quinkler, Marcus / Zelissen, Pierre. ·Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Headington, Oxford OX3 7EJ, UK. · ·Eur J Endocrinol · Pubmed #24031090.

ABSTRACT: BACKGROUND: Conventional glucocorticoid (GC) replacement for patients with adrenal insufficiency (AI) is inadequate. Patients with AI continue to have increased mortality and morbidity and compromised quality of life despite treatment and monitoring. OBJECTIVES: i) To review current management of AI and the unmet medical need based on literature and treatment experience and ii) to offer practical advice for managing AI in specific clinical situations. METHODS: The review considers the most urgent questions endocrinologists face in managing AI and presents generalised patient cases with suggested strategies for treatment. RESULTS: Optimisation and individualisation of GC replacement remain a challenge because available therapies do not mimic physiological cortisol patterns. While increased mortality and morbidity appear related to inadequate GC replacement, there are no objective measures to guide dose selection and optimisation. Physicians must rely on experience to recognise the clinical signs, which are not unique to AI, of inadequate treatment. The increased demand for corticosteroids during periods of stress can result in a life-threatening adrenal crisis (AC) in a patient with AI. Education is paramount for patients and their caregivers to anticipate, recognise and provide proper early treatment to prevent or reduce the occurrence of ACs. CONCLUSIONS: This review highlights and offers suggestions to address the challenges endocrinologists encounter in treating patients with AI. New preparations are being developed to better mimic normal physiological cortisol levels with convenient, once-daily dosing which may improve treatment outcomes.