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Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion].
Endocr J. 2016 Sep 30; 63(9):765-784.EJ

Abstract

This clinical practice guideline of the diagnosis and treatment of adrenal insufficiency (AI) including adrenal crisis was produced on behalf of the Japan Endocrine Society. This evidence-based guideline was developed by a committee including all authors, and was reviewed by a subcommittee of the Japan Endocrine Society. The Japanese version has already been published, and the essential points have been summarized in this English language version. We recommend diagnostic tests, including measurement of basal cortisol and ACTH levels in combination with a rapid ACTH (250 μg corticotropin) test, the CRH test, and for particular situations the insulin tolerance test. Cut-off values in basal and peak cortisol levels after the rapid ACTH or CRH tests are proposed based on the assumption that a peak cortisol level ≥18 μg/dL in the insulin tolerance test indicates normal adrenal function. In adult AI patients, 15-25 mg hydrocortisone (HC) in 2-3 daily doses, depending on adrenal reserve and body weight, is a basic replacement regime for AI. In special situations such as sickness, operations, pregnancy and drug interactions, cautious HC dosing or the correct choice of glucocorticoids is necessary. From long-term treatment, optimal diurnal rhythm and concentration of serum cortisol are important for the prevention of cardiovascular disease and osteoporosis. In maintenance therapy during the growth period of patients with 21-hydroxylase deficiency, proper doses of HC should be used, and long-acting glucocorticoids should not be used. Education and carrying an emergency card are essential for the prevention and rapid treatment of adrenal crisis.

Authors+Show Affiliations

Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoa 814-0180, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Practice Guideline

Language

eng

PubMed ID

27350721

Citation

Yanase, Toshihiko, et al. "Diagnosis and Treatment of Adrenal Insufficiency Including Adrenal Crisis: a Japan Endocrine Society Clinical Practice Guideline [Opinion]." Endocrine Journal, vol. 63, no. 9, 2016, pp. 765-784.
Yanase T, Tajima T, Katabami T, et al. Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]. Endocr J. 2016;63(9):765-784.
Yanase, T., Tajima, T., Katabami, T., Iwasaki, Y., Tanahashi, Y., Sugawara, A., Hasegawa, T., Mune, T., Oki, Y., Nakagawa, Y., Miyamura, N., Shimizu, C., Otsuki, M., Nomura, M., Akehi, Y., Tanabe, M., & Kasayama, S. (2016). Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]. Endocrine Journal, 63(9), 765-784.
Yanase T, et al. Diagnosis and Treatment of Adrenal Insufficiency Including Adrenal Crisis: a Japan Endocrine Society Clinical Practice Guideline [Opinion]. Endocr J. 2016 Sep 30;63(9):765-784. PubMed PMID: 27350721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]. AU - Yanase,Toshihiko, AU - Tajima,Toshihiro, AU - Katabami,Takuyuki, AU - Iwasaki,Yasumasa, AU - Tanahashi,Yusuke, AU - Sugawara,Akira, AU - Hasegawa,Tomonobu, AU - Mune,Tomoatsu, AU - Oki,Yutaka, AU - Nakagawa,Yuichi, AU - Miyamura,Nobuhiro, AU - Shimizu,Chikara, AU - Otsuki,Michio, AU - Nomura,Masatoshi, AU - Akehi,Yuko, AU - Tanabe,Makito, AU - Kasayama,Soji, Y1 - 2016/06/24/ PY - 2016/6/29/pubmed PY - 2017/3/4/medline PY - 2016/6/29/entrez SP - 765 EP - 784 JF - Endocrine journal JO - Endocr J VL - 63 IS - 9 N2 - This clinical practice guideline of the diagnosis and treatment of adrenal insufficiency (AI) including adrenal crisis was produced on behalf of the Japan Endocrine Society. This evidence-based guideline was developed by a committee including all authors, and was reviewed by a subcommittee of the Japan Endocrine Society. The Japanese version has already been published, and the essential points have been summarized in this English language version. We recommend diagnostic tests, including measurement of basal cortisol and ACTH levels in combination with a rapid ACTH (250 μg corticotropin) test, the CRH test, and for particular situations the insulin tolerance test. Cut-off values in basal and peak cortisol levels after the rapid ACTH or CRH tests are proposed based on the assumption that a peak cortisol level ≥18 μg/dL in the insulin tolerance test indicates normal adrenal function. In adult AI patients, 15-25 mg hydrocortisone (HC) in 2-3 daily doses, depending on adrenal reserve and body weight, is a basic replacement regime for AI. In special situations such as sickness, operations, pregnancy and drug interactions, cautious HC dosing or the correct choice of glucocorticoids is necessary. From long-term treatment, optimal diurnal rhythm and concentration of serum cortisol are important for the prevention of cardiovascular disease and osteoporosis. In maintenance therapy during the growth period of patients with 21-hydroxylase deficiency, proper doses of HC should be used, and long-acting glucocorticoids should not be used. Education and carrying an emergency card are essential for the prevention and rapid treatment of adrenal crisis. SN - 1348-4540 UR - https://www.unboundmedicine.com/medline/citation/27350721/Diagnosis_and_treatment_of_adrenal_insufficiency_including_adrenal_crisis:_a_Japan_Endocrine_Society_clinical_practice_guideline_[Opinion]_ L2 - https://dx.doi.org/10.1507/endocrj.EJ16-0242 DB - PRIME DP - Unbound Medicine ER -