SSRN Electronic Journal,
Год журнала:
2022,
Номер
unknown
Опубликована: Янв. 1, 2022
Background:
Very
little
is
known
about
the
epidemiology
of
adrenal
crises
(AC)
and
insufficiency
(AI)
in
adolescents
young
adults.
Methods:
Data
on
all
admissions
to
Australian
hospitals
between
2000/1
2019/20
for
a
principal
diagnosis
AI
(including
AC)
10-24
year
olds
were
extracted
from
national
repository.
Age
sex
specific
rates
age
adjusted
compared.
Findings:
Over
study,
there
3386
AI;
24.0%
(n=812)
an
AC
50·7%
(n=1774)
secondary
AI.
Age-adjusted
increased
31·70/million
54·68/million
(p<0·0001).
also
increased,
most
notably
second
decade
(from
5·80/million
2010/11
15·75/million
2019/20)
(p<0·00001).
Average
admission
comparable
sexes,
but
significantly
females,
especially
those
aged
20
24
years,
whose
rate
(39·65/million)
was
higher
than
corresponding
(3·15/million)
age-adjusted
SAI
males
(23·92/million)
females
(15·47/million)
However,
only
among
11·81/million
22·12/million
2019/20),
with
increase
20-24
old
5·07/million
2010
20·42/million
congenital
hyperplasia,
primary
(PAI)
drug-induced
did
not
change
over
study.Interpretation:
AC/AI
first
two
decades
this
century
emerging
adult
population,
particularly
who
experienced
marked
rates,
evident
decade.
Although
uncertain,
possible
explanations
include:
dose
glucocorticoid
replacement;
non-adherence
therapy;
psychosocial
factors;
difficulty
transition
services.
Admissions
while
PAI,
CAH
remained
constant.Funding
Information:
None.Declaration
Interests:
None.Ethics
Approval
Statement:
As
data
used
these
analyses
publicly
available
datasets,
no
ethics
clearance
required
conduct
study.
Endocrine Practice,
Год журнала:
2025,
Номер
unknown
Опубликована: Март 1, 2025
Individuals
with
adrenal
insufficiency
(AI)
are
at
risk
of
acute
crisis
and
death,
particularly
during
illness
or
trauma,
may
require
rapid
treatment
parenteral
glucocorticoid
such
as
hydrocortisone
(HC)
to
manage
a
crisis.
Current
guidelines
recommend
timely
self-injection
in
an
evolving
Little
is
known
about
the
patient
experience
emergency
injections.
We
surveyed
people
regarding
success
In
2022
survey
was
conducted
through
National
Adrenal
Diseases
Foundation
website
individuals
AI
their
caregivers
managing
They
reported
on
events
that
required
cortisol
injection
failure
injection,
context
event
reasons
for
failure,
RESULTS:
Nearly
half
(41%)
insufficient
patients
were
unable
self-administer
citing
effects
crisis-associated
confusion
major
barriers.
Failed
injections
led
bad
outcomes
(sicker,
need
hospitalization,
death)
36%
cases.
Effective,
timely,
management
impending
can
prevent
progression
multisystem
requiring
ICU
care,
death.
Reliance
solely
result
worse
outcomes.
Treating
physicians
should
include
education
specific
practical
instruction
technique,
well
potential
assistance
FDA
approval
auto
injector,
greater
engagement
EMS
clinicians,
hospital
staff,
other
healthcare
professionals,
key
future
crises.
Endocrinology and Metabolism,
Год журнала:
2022,
Номер
37(4), С. 587 - 598
Опубликована: Июль 8, 2022
A
plethora
of
negative
long-term
outcomes
have
been
associated
with
congenital
adrenal
hyperplasia
(CAH).
The
causes
are
multiple
and
involve
supra-physiological
gluco-
mineralocorticoid
replacement,
excess
androgens
both
intrauterine
postnatal,
elevated
steroid
precursor
adrenocorticotropic
hormone
levels,
living
a
condition
as
well
the
proximity
cytochrome
P450
family
21
subfamily
member
2
(<i>CYP21A2</i>)
gene
to
other
genes.
This
review
aims
discuss
different
CAH.
Hormone and Metabolic Research,
Год журнала:
2024,
Номер
56(01), С. 45 - 50
Опубликована: Янв. 1, 2024
Abstract
Transition
medicine
aims
at
the
coordinated
transfer
of
young
patients
with
a
chronic
disease
from
paediatric
to
adult
care.
The
present
study
reflects
20
years
experience
in
transitioning
congenital
adrenal
hyperplasia
(CAH)
single
center
setting.
Our
endocrine
transition-clinic
was
established
2002
and
offers
joint
consultations.
Data
were
evaluated
retrospectively
2005
2008
present.
Fifty-nine
(29
males)
transferred.
Median
age
18.4
(17.6–23.6).
Ninety
percent
presented
21-hydroxlase-deficiency
(21-OHD),
38
(23
m)
salt-wasting
(sw),
7
(1
simple-virilising
(sv)
8
(3
non-classic
(nc)
form.
Rarer
enzyme
deficiencies
found
6
cases:
17α-OHD
(2
sisters),
P450-oxidoreductase-deficiency
siblings),
3β-hydroxysteroid-dehydrogenase-deficiency
11β-OHD
female).
Thirty-four
(57.6%,
are
presently
still
attending
clinic,
1
patient
(1.7%,
moved
away
24
(40.7%,
lost
follow-up
(13
sw-21-OHD,
sv-21-OHD,
5
nc-21-OHD).
Thirty-seven
(62.7%)
attended
clinic
for
>2
after
transfer,
17
(28.8%)
>10
years.
In
group,
median
time
attendance
16.3
months
(0–195.2).
Defining
successful
as
two
or
more
visits
department
initial
consultation
transition
efficient
84.7%
cases.
A
seamless
care
is
essential
adolescents
CAH.
It
requires
continuous
support
during
period,
remains
challenging,
necessitates
adequate
funding.
The
necessity
for
a
well-prepared
and
sustainable
transition
to
adult
care
is
evident,
especially
adolescents
with
complex
diseases.
For
the
field
of
endocrinology
this
particularly
involves
transfer
in
cases
hypothalamic-pituitary
dysfunction,
diseases
adrenal
thyroid
glands,
disorders
glucose
metabolism
as
well
rare
genetically
linked
syndromes
associated
endocrinopathies,
hereditary
bone
tumor
predisposition
syndromes.
These
often
belong
so-called
group
necessitate
high
level
specialized
multidisciplinary
over
entire
lifespan.
main
priorities
are
age-specific
sex-specific
aspects
various
individual
that
can
develop
during
course
disease.
treatment
targets
also
change
period
from
adolescence
adulthood.
It
has
been
shown
joint
accompaniment
young
adults
by
pediatricians
specialists
internal
medicine
throughout
complete
individually
adapted
process
positive
effects
on
establishment
an
adequate
long-term
medical
situation
patients.
This
prerequisite
reduction
morbidity
mortality
improvement
quality
life.
demands
outpatient
hormone
metabolic
very
close
cooperation
between
pediatric
teams.
only
permanently
comprehensively
succeed
when
sufficient
personnel
infrastructural
support
available
order
implement
necessary
interprofessional
optimal
management
patients
chronic
mostly
The Journal of Clinical Endocrinology & Metabolism,
Год журнала:
2023,
Номер
108(7), С. 1797 - 1805
Опубликована: Янв. 11, 2023
Abstract
Adrenal
crisis
continues
to
be
an
important
cause
of
death
despite
being
a
preventable
condition.
Significant
deficits
in
patient
education
the
prevention
adrenal
have
been
identified
as
contributor
risk,
importance
highlighted
international
guidelines.
Deficits
clinician
also
risk
factors
for
although
they
not
addressed.
We
use
3
clinical
cases
highlight
role
both
and
crisis,
review
what
is
known
about
related
insufficiency
provide
possible
approach
addressing
with
aim
reducing
through
education.
Frontiers in Endocrinology,
Год журнала:
2022,
Номер
13
Опубликована: Сен. 20, 2022
Very
little
is
known
about
the
epidemiology
of
adrenal
crises
(AC)
and
insufficiency
(AI)
in
adolescents
young
adults.Data
on
all
admissions
to
Australian
hospitals
between
2000/1
2019/20
for
a
principal
diagnosis
AI
(including
AC)
10-24
year
olds
were
extracted
from
national
repository.
Age
sex-specific
rates
age-adjusted
compared.Over
study,
there
3386
AI;
24.0%
(n=812)
an
AC
50·7%
(n=1718)
secondary
AI.
Age-adjusted
increased
31·70/million
54·68/million
(p<0·0001).
also
increased,
most
notably
second
decade
(from
5·80/million
2010/11
15·75/million
2019/20)
(p<0·00001).
Average
admission
comparable
sexes,
but
significantly
females,
especially
those
aged
20
24
years,
whose
rate
(39·65/million)
was
higher
than
corresponding
(3·15/million)
SAI
males
(23·92/million)
females
(15·47/million)
However,
only
among
11·81/million
22·12/million
2019/20),
with
increase
20-24
old
5·07/million
2010
20·42/million
adjusted
congenital
hyperplasia,
primary
(PAI)
drug-induced
did
not
change
over
study.AC/AI
first
two
decades
this
century
emerging
adult
population,
particularly
who
experienced
marked
rates,
evident
decade.
Although
uncertain,
possible
explanations
include:
dose
glucocorticoid
replacement;
non-adherence
therapy;
psychosocial
factors;
difficulty
transition
services.
Admissions
while
PAI
CAH
remained
constant.
Turkish Journal of Emergency Medicine,
Год журнала:
2023,
Номер
23(3), С. 139 - 148
Опубликована: Янв. 9, 2023
Circulatory
shock
is
a
common
condition
that
carries
high
morbidity
and
mortality.
This
review
aims
to
update
the
critical
steps
in
managing
types
of
adult
patients
admitted
medical
emergency
intensive
care
units.
A
literature
was
performed
by
searching
PubMed,
EMBASE
Ovid,
Cochrane
Library,
using
following
search
items:
(“shock”
OR
“circulatory
shock”
“septic
“cardiogenic
shock”)
AND
(“management”
“treatment”
“resuscitation”).
The
emphasizes
prompt
identification
with
tissue
hypoperfusion,
knowledge
underlying
pathophysiological
mechanism,
initial
fluid
resuscitation
balanced
crystalloids,
norepinephrine
as
preferred
vasopressor
septic
profound
cardiogenic
shock,
tailored
intervention
addressing
specific
etiologies.
Point-of-care
ultrasound
may
help
evaluate
an
undifferentiated
determine
responsiveness.
approach
improving;
however,
confirmatory
studies
are
required
for
many
existing
(e.g.,
amount
fluids
steroids)
emerging
angiotensin
II)
therapies.
Knowledge
gaps
wide
variations
persist
needs
urgent
improve
outcomes.
