Document Detail

Clinical Review#: The diagnosis and management of central hypoadrenalism.
MedLine Citation:
PMID:  20719838     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Adrenal failure secondary to hypothalamo-pituitary disease is a common clinical problem which has serious repercussions. It is essential to perform validated diagnostic procedures and manage such patients with clear objectives and based on well-established replacement programs.
EVIDENCE ACQUISITION: PubMed was searched for all data reflecting pituitary hypoadrenalism dating back to 1960 in order to establish a published database.
EVIDENCE SYNTHESIS: The results from published studies were assessed in the light of the author's extensive personal experience dating back some 30 yr in clinical endocrinology, in an attempt to provide clear diagnostic and management advice.
CONCLUSIONS: While much of the physiology of the hypothalamo-pituitary-adrenal axis is well understood, its clinical assessment and diagnostic procedures to establish the need for replacement are still far from perfect, and to a certain extent clinical judgement is still vital. In terms of replacement therapies, these are still far from optimal in terms of quality of life and mortality, although they are increasingly being based on objective evidence rather than established practice. However, it is anticipated that newer replacement protocols will improve a situation that has previously changed little for many years.
Ashley B Grossman
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-08-18
Journal Detail:
Title:  The Journal of clinical endocrinology and metabolism     Volume:  95     ISSN:  1945-7197     ISO Abbreviation:  J. Clin. Endocrinol. Metab.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-05     Completed Date:  2010-12-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4855-63     Citation Subset:  AIM; IM    
Barts and the London School of Medicine, London, United Kingdom.
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MeSH Terms
Adrenal Insufficiency / diagnosis*,  drug therapy*,  physiopathology
Glucocorticoids / therapeutic use
Hypothalamo-Hypophyseal System / physiopathology*
Pituitary-Adrenal System / physiopathology*
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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