British Society of Gastroenterology guidelines for diagnosis and management of autoimmune hepatitis DOI
Dermot Gleeson,

Rosemary Bornand,

Ann Brownlee

et al.

Gut, Journal Year: 2025, Volume and Issue: unknown, P. gutjnl - 333171

Published: April 1, 2025

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease which, if untreated, often leads to cirrhosis, failure and death. The last British Society of Gastroenterology (BSG) guideline for the management AIH was published in 2011. Since then, our understanding has advanced many areas. This update previous commissioned by BSG developed multidisciplinary group. aim this review summarise current evidence, order inform guide diagnosis patients with its variant syndromes. main focus on adults, but guidelines should also be relevant older children adolescents.

Language: Английский

ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease DOI Open Access
Hannah Gordon, Johan Burisch, Pierre Ellul

et al.

Journal of Crohn s and Colitis, Journal Year: 2023, Volume and Issue: 18(1), P. 1 - 37

Published: June 23, 2023

Language: Английский

Citations

120
European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency DOI Creative Commons
Felix Beuschlein, Tobias Else, Irina Bancos

et al.

The Journal of Clinical Endocrinology & Metabolism, Journal Year: 2024, Volume and Issue: 109(7), P. 1657 - 1683

Published: May 9, 2024

Abstract Glucocorticoids are widely prescribed as anti-inflammatory and immunosuppressive agents. This results in at least 1% of the population using chronic glucocorticoid therapy, being risk for glucocorticoid-induced adrenal insufficiency. is dependent on dose, duration potency glucocorticoid, route administration, individual susceptibility. Once insufficiency develops or suspected, it necessitates careful education management affected patients. Tapering glucocorticoids can be challenging when symptoms withdrawal develop, which overlap with those In general, tapering more rapidly within a supraphysiological range, followed by slower taper physiological dosing. The degree persistence HPA axis suppression after cessation therapy overall exposure recovery function varies greatly amongst individuals. first European Society Endocrinology/Endocrine joint clinical practice guideline provides guidance this clinically relevant condition to aid clinicians involved care patients therapy.

Language: Английский

Citations

19
Progesterone as an Anti-Inflammatory Drug and Immunomodulator: New Aspects in Hormonal Regulation of the Inflammation DOI Creative Commons
Т. А. Федотчева,

Н. И. Федотчева,

Nikolai L. Shimanovsky

et al.

Biomolecules, Journal Year: 2022, Volume and Issue: 12(9), P. 1299 - 1299

Published: Sept. 14, 2022

The specific regulation of inflammatory processes by steroid hormones has been actively studied in recent years, especially progesterone (P4) and progestins. mechanisms the anti-inflammatory immunomodulatory P4 action are not fully clear. effects can be defined as nonspecific, associated with inhibition NF-κB COX, well prostaglandin synthesis, or specific, T-cell activation, production pro- cytokines, phenomenon immune tolerance. its derivatives (progestins) also include proliferative signaling pathways antagonistic against estrogen receptor beta-mediated a proinflammatory mitogenic factor. is accomplished through participation (PR) chaperones HSP90, immunophilins FKBP51 FKBP52, which validated targets clinically approved immunosuppressive drugs. HSP90 inhibitors, tacrolimus cyclosporine, manifested, among other factors, due to their formation an active ligand–receptor complex interaction constituent immunophilins. Pharmacological agents such inhibitors restore lost effect glucocorticoids chronic autoimmune diseases. By regulating activity it possible increase decrease hormonal signaling, during development hormone resistance. combined immunophilin suppressors may promising strategy treatment diseases, including endometriosis, stress-related disorders, rheumatoid arthritis, miscarriages. Presumably, receptor- immunophilin-targeted drugs act synergistically, allowing for lower dose each.

Language: Английский

Citations

64
The Relationship between COVID-19 and Hypothalamic–Pituitary–Adrenal Axis: A Large Spectrum from Glucocorticoid Insufficiency to Excess—The CAPISCO International Expert Panel DOI Open Access
Mojca Jensterle, Rok Herman, Andrej Janež

et al.

International Journal of Molecular Sciences, Journal Year: 2022, Volume and Issue: 23(13), P. 7326 - 7326

Published: June 30, 2022

Coronavirus disease 2019 (COVID-19) is a highly heterogeneous regarding severity, vulnerability to infection due comorbidities, and treatment approaches. The hypothalamic-pituitary-adrenal (HPA) axis has been identified as one of the most critical endocrine targets severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that might significantly impact outcomes after infection. Herein we review rationale for glucocorticoid use in setting COVID-19 emphasize need have low index suspicion glucocorticoid-induced adrenal insufficiency, adjusting formulation used, dose, duration, underlying health problems. We also address several additional mechanisms may cause HPA dysfunction, including illness-related corticosteroid direct cytopathic impacts SARS-CoV-2 on adrenals, pituitary, hypothalamus, immune-mediated inflammations, small vessel vasculitis, microthrombotic events, resistance cortisol receptors, impaired post-receptor signaling, well dissociation ACTH regulation. discuss increased risk more illness patients with pre-existing disorders axis, from insufficiency excess. These insights into complex regulation reveal how body performs its adaptive survival mechanism during infection, such SARS-CoV-2, many parameters disbalance this adaptation.

Language: Английский

Citations

54
Home Waking Salivary Cortisone to Screen for Adrenal Insufficiency DOI
Miguel Debono, Charlotte Elder, Jen Lewis

et al.

NEJM Evidence, Journal Year: 2023, Volume and Issue: 2(2)

Published: Jan. 6, 2023

BACKGROUND: Worldwide, adults and children are at risk of adrenal insufficiency as a result suppression from use anti-inflammatory glucocorticoids opiates, well infectious diseases. The adrenocorticotropin (ACTH) stimulation test is the reference standard for diagnosis but requires clinic attendance venesection. Salivary cortisone reflects free serum cortisol, samples can be collected home posted to laboratory. We tested whether waking salivary level could used screen insufficiency. METHODS: A prospective, diagnostic accuracy study was performed in patients high Patients sample on then attended clinical facility an ACTH test. measured by liquid chromatography–tandem mass spectrometry. Receiver-operating characteristic curves were computed, positive negative predictive values calculated. RESULTS: Two hundred twenty recruited. As test, prevalence 44%. area under receiver-operating curve predictor 0.95 (95% confidence interval [CI], 0.92 0.97). Cutoffs ensure minimum 95% sensitivity specificity gave value 96% CI, 90 99) 87 exclude confirm insufficiency, respectively. Waking data provided information similar that 70% participants. Eighty-three percent preferred collection attendance. CONCLUSIONS: Home sampling has found at-home more convenient than hospital-based (Funded National Institute Health Research.)

Language: Английский

Citations

38
European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency DOI Creative Commons
Felix Beuschlein, Tobias Else, Irina Bancos

et al.

European Journal of Endocrinology, Journal Year: 2024, Volume and Issue: 190(5), P. G25 - G51

Published: May 1, 2024

Abstract Glucocorticoids are widely prescribed as anti-inflammatory and immunosuppressive agents. This results in at least 1% of the population using chronic glucocorticoid therapy, being risk for glucocorticoid-induced adrenal insufficiency. is dependent on dose, duration potency glucocorticoid, route administration, individual susceptibility. Once insufficiency develops or suspected, it necessitates careful education management affected patients. Tapering glucocorticoids can be challenging when symptoms withdrawal develop, which overlap with those In general, tapering more rapidly within a supraphysiological range, followed by slower taper physiological dosing. The degree persistence HPA axis suppression after cessation therapy overall exposure recovery function varies greatly amongst individuals. first European Society Endocrinology/Endocrine joint clinical practice guideline provides guidance this clinically relevant condition to aid clinicians involved care patients therapy.

Language: Английский

Citations

16
Iatrogenic adrenal insufficiency in adults DOI
Julie Martin‐Grace, Maria Tomkins, Michael O’Reilly

et al.

Nature Reviews Endocrinology, Journal Year: 2024, Volume and Issue: 20(4), P. 209 - 227

Published: Jan. 25, 2024

Language: Английский

Citations

11
Effects and mechanisms of perioperative medications on the hypothalamic pituitary adrenal response to surgical injury: A narrative review DOI
Yan Feng,

Pan Chang,

Jin Liu

et al.

Journal of Clinical Anesthesia, Journal Year: 2024, Volume and Issue: 94, P. 111367 - 111367

Published: Jan. 16, 2024

Language: Английский

Citations

10
Cushing syndrome DOI
Lynnette K. Nieman, Frédéric Castinetti, John Newell‐Price

et al.

Nature Reviews Disease Primers, Journal Year: 2025, Volume and Issue: 11(1)

Published: Jan. 23, 2025

Language: Английский

Citations

1
Adrenal insufficiency DOI Open Access
Rajeev Kumar, W Wassif

Journal of Clinical Pathology, Journal Year: 2022, Volume and Issue: 75(7), P. 435 - 442

Published: May 9, 2022

Adrenal insufficiency (AI), first described by Thomas Addison in 1855, is characterised inadequate hormonal production the adrenal gland, which could either be primary, due to destruction of cortex, or secondary/tertiary, lack adrenocorticotropic hormone its stimulation corticotropin-releasing hormone. This was an invariably fatal condition Addison’s days with most patients dying within a few years diagnosis. However, discovery cortisone 1940s not only improved life expectancy these but also had dramatic effect on their overall quality life. The diagnosis, easily confirmed demonstrating inappropriately low cortisol secretion, often delayed months, and many present acute crisis. Sudden withdrawal from chronic glucocorticoid therapy common cause AI. Currently, there remains wide variation management this across Europe. As primary AI relatively rare condition, medical specialists will manage handful career. Despite advances recent years, currently no curative option, modern replacement regimens fail adequately mimic physiological rhythm. A number new approaches including allograft adrenocortical tissue stem cell are being tried remain largely experimental.

Language: Английский

Citations

36