Sürrenal Yetmezlik
Özet
Sürrenal yetmezlik, hayatı tehdit eden sonuçlara yol açabilen, mineralokortikoidlerin veya adrenal androjenlerin sentez veya salgılanmasında yetersizlik olsun ya da olmasn, glukokortikoidlerin sentezindeki yetersizlik sonucu oluşan bir hastalıktır. Normalde, sürrenal bezler stres durumlarında kortikosteroid salgılar ve vücudun stresle başa çıkmasına yardımcı olur. Ancak kritik hastalık durumlarında, aşırı stres ve vücuttaki inflamatuar yanıtlar sürrenal bezleri etkileyebilir ve kortikosteroid üretimini olumsuz yönde etkileyebilir.
Yoğun bakım ünitesinde yatmakta olan kritik hastalarda meydana gelen sürrenal yetmezlik tablosu ise “Kritik Hastalıkla İlişkili Kortikosteroid Yetmezliği” olarak adlandırılır. Kritik hastalıkla ilişkili kortikosteroid yetmezliği, vücutta stresle başa çıkma mekanizmasının bozulmasına neden olabilir. Kortizol eksikliği, hipotansiyon, hipoglisemi, elektrolit dengesizlikleri, inflamasyon ve immün yanıtların düzensizleşmesi gibi ciddi komplikasyonlara yol açabilir. Bu durum, hastanın kritik hastalık durumunda iyileşme sürecini olumsuz etkileyebilir ve hayati tehlikelere neden olabilir.
Kritik hastalıkla ilişkili sürrenal yetmezlik, acil tıbbi müdahale gerektiren bir durumdur. Tedavi genellikle kortikosteroidlerin eksikliğin yerine konmasıyla yapılır. Kritik hastalıkla ilgili yoğun bakım birimlerinde ve cerrahi operasyonlarda bu durumu önlemek ve yönetmek için özel protokoller ve tedavi stratejileri kullanılmaktadır.
Adrenal insufficiency arises due to a deficiency in the synthesis of glucocorticoids, regardless of whether there is an insufficiency in the synthesis or secretion of mineralocorticoids or adrenal androgens. This condition can lead to life-threatening consequences. Normally, the adrenal glands secrete corticosteroids in response to stress, aiding the body in coping with stressors. However, in cases of critical illness, extreme stress, and inflammatory responses, the adrenal glands can be adversely affected, leading to a negative impact on corticosteroid production.
Adrenal insufficiency in critically ill patients within the intensive care unit is referred to as “Critical Illness-Associated Corticosteroid Insufficiency.” Corticosteroid insufficiency associated with critical illness can compromise the body’s stress coping mechanisms. Cortisol deficiency can result in severe complications such as hypotension, hypoglycemia, electrolyte imbalances, inflammation, and dysregulation of immune responses. These complications can detrimentally affect the patient’s recovery process during critical illness and pose life-threatening situations.
Adrenal insufficiency associated with critical illness requires prompt medical attention. Treatment typically involves replacing the deficiency with corticosteroids. Specialized protocols and treatment strategies are employed in intensive care units and surgical operations related to critical illness to prevent and manage this condition.
Referanslar
Neary N, Nieman L. Adrenal insufficiency-etiology, diagnosis and treatment. Current Opinion in Endocrinology, Diabetes and Obesity. 2010;17(3):217.
Bornstein SR. Predisposing factors for adrenal insufficiency. New England Journal of Medicine. 2009;360(22):2328–39.
Varan Ö, Gürlek A. Adrenal Yetmezlik, Tanı ve Tedavi Algoritması. A Sistemic Review. Yoğun Bakım Dergisi. 2010;9(4):200–7.
Addison T. On the constitutional and local effects of disease of the supura-renal capsules. Highley, London. 1855;
Løvås K, Husebye ES. Replacement therapy for Addison’s disease: recent developments. Expert Opinion Investigational Drugs. 2008;17(4):497–509.
Regal M, Páramo C, Sierra JM, et al. Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clinical Endocrinology. 2001;55(6):735–40.
Woods CP, Argese N, Chapman M, et al. Adrenal suppression in patients taking inhaled glucocorticoids is highly prevalent and management can be guided by morning cortisol. European Journal of Endocrinology. 2015;173(5):633–42.
Bleicken B, Ventz M, Quinkler M, et al. Delayed diagnosis of adrenal insufficiency is common: a cross-sectional study in 216 patients. The American Journal of the Medical Sciences. 2010;339(6):525–31.
Allolio B. Extensive expertise in endocrinology: adrenal crisis. European Journal of Endocrinology. 2015;172(3):R115–24.
Hahner S, Spinnler C, Fassnacht M, et al. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study. The Journal of Clinical Endocrinology & Metabolism. 2015;100(2):407–16.
Rushworth RL, Torpy DJ, Falhammar H. Adrenal crises: perspectives and research directions. Endocrine. 2017;55:336–45.
Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2016;101(2):364–89.
Erichsen MM, Løvås K, Skinningsrud B, et al. Clinical, immunological, and genetic features of autoimmune primary adrenal insufficiency: observations from a Norwegian registry. The Journal of Clinical Endocrinology & Metabolism. 2009;94(12):4882–90.
Dunlop D. Eight-six Cases of Addison’s Disease. British Medical Journal. 1963;2(5362):887.
Hellesen A, Bratland E, Husebye ES. Autoimmune Addison’s disease–An update on pathogenesis. Annales d'Endocrinologie. Elsevier; 2018. p. 157–63.
Afreen B, Khan KA, Riaz A. Adrenal insufficiency in Pakistani HIV infected patients. Journal of Ayub Medical College Abbottabad. 2017;29(3):428–31.
Mofokeng TRP, Beshyah SA, Mahomed F, et al. Significant barriers to diagnosis and management of adrenal insufficiency in Africa. Endocrine Connections. 2020;9(5):445.
Odeniyi IA, Fasanmade OA, Ajala MO, Ohwovoriole AE. Adrenocortical function in Nigerians with human immunodeficiency virus infection. Ghana Medical Journal. 2013;47(4):171.
Laureti S, De Bellis A, Muccitelli VI, et al. Levels of adrenocortical autoantibodies correlate with the degree of adrenal dysfunction in subjects with preclinical Addison’s disease. The Journal of Clinical Endocrinology & Metabolism. 1998;83(10):3507–11.
Betterle C, Dal Pra C, Mantero F, et al. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocrine Reviews. 2002;23(3):327–64.
Chantzichristos D, Persson A, Eliasson B, et al. Incidence, prevalence and seasonal onset variation of Addison’s disease among persons with type 1 diabetes mellitus: nationwide, matched cohort studies. European Journal of Endocrinology. 2018;178(1):113–20.
Herndon J, Nadeau AM, Davidge-Pitts CJ, et al. Primary adrenal insufficiency due to bilateral infiltrative disease. Endocrine. 2018;62:721–8.
Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. The Lancet. 2014;383(9935):2152–67.
Tomlinson JW, Holden N, Hills RK, et al. Association between premature mortality and hypopituitarism. The Lancet. 2001;357(9254):425–31.
Bates AS, Van’t Hoff W, Jones PJ, et al. The effect of hypopituitarism on life expectancy. The Journal of Clinical Endocrinology & Metabolism. 1996;81(3):1169–72.
Appelman-Dijkstra NM, Kokshoorn NE, Dekkers OM, et al. Pituitary dysfunction in adult patients after cranial radiotherapy: systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2011;96(8):2330–40.
Carosi G, Malchiodi E, Ferrante E, et al. Hypothalamic-pituitary axis in non-functioning pituitary adenomas: focus on the prevalence of isolated central hypoadrenalism. Neuroendocrinology. 2015;102(4):267–73.
Jenkins PJ, Bates P, Carson MN, et al, Group UKNARS. Conventional pituitary irradiation is effective in lowering serum growth hormone and insulin-like growth factor-I in patients with acromegaly. The Journal of Clinical Endocrinology & Metabolism. 2006;91(4):1239–45.
Knappe UJ, Petroff D, Quinkler M, et al. Fractionated radiotherapy and radiosurgery in acromegaly: analysis of 352 patients from the German Acromegaly Registry. European Journal of Endocrinology. 2020;182(3):275–84.
Broersen LHA, Pereira AM, Jørgensen JOL, et al. Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2015;100(6):2171–80.
Mebrahtu TF, Morgan AW, Keeley A, et al. Dose dependency of iatrogenic glucocorticoid excess and adrenal insufficiency and mortality: a cohort study in England. The Journal of Clinical Endocrinology & Metabolism. 2019;104(9):3757–67.
Joseph RM, Hunter AL, Ray DW, et al. Systemic glucocorticoid therapy and adrenal insufficiency in adults: a systematic review. Seminars in Arthritis and Rheumatism. Elsevier; 2016. p. 133–41.
Pofi R, Feliciano C, Sbardella E, et al. The short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function. The Journal of Clinical Endocrinology & Metabolism. 2018;103(8):3050–9.
Selye H. The general adaptation syndrome and the diseases of adaptation. The Journal of Clinical Endocrinology & Metabolism. 1946;6(2):117–230.
Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. Journal of the American Medical Association. 2002;288(7):862–71.
Marik PE, Pastores SM, Annane D, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Critical Care Medicine. 2008;36(6):1937–49.
Marik PE, Zaloga GP. Adrenal insufficiency in the critically ill: a new look at an old problem. Chest. 2002;122(5):1784–96.
Garcia-Vidal C, Calbo E, Pascual V, et al. Effects of systemic steroids in patients with severe community-acquired pneumonia. European Respiratory Journal. 2007;30(5):951–6.
Dimopoulou I, Tsagarakis S. Hypothalamic-pituitary dysfunction in critically ill patients with traumatic and nontraumatic brain injury. Applied Physiology in Intensive Care Medicine 2: Physiological Reviews and Editorials. 2012;163–71.
Adrenal ve Gonadal Hastalıklar Çalışma Grubu. Adrenal ve Gonadal Hastalıklar Kılavuzu. Ankara; 2022.
Annane D, Pastores SM, Rochwerg B, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Medicine. 2017;43:1751–63.
Annane D, Maxime V, Ibrahim F, et al. Diagnosis of adrenal insufficiency in severe sepsis and septic shock. American Journal of Respiratory and Critical Care Medicine. 2006;174(12):1319–26.
Jessop DS, Turner-Cobb JM. Measurement and meaning of salivary cortisol: a focus on health and disease in children. Stress. 2008;11(1):1–14.
Marik PE, Zaloga GP. Adrenal insufficiency during septic shock. Critical Care Medicine. 2003;31(1):141–5.
Annane D, Sébille V, Bellissant E, Group GI 05 S. Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome. Critical Care Medicine. 2006;34(1):22–30.
Ospina NS, Al Nofal A, Bancos I, et al. ACTH stimulation tests for the diagnosis of adrenal insufficiency: systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2016;101(2):427–34.
Ho JT, Al-Musalhi H, Chapman MJ, et al. Septic shock and sepsis: a comparison of total and free plasma cortisol levels. The Journal of Clinical Endocrinology & Metabolism. 2006;91(1):105–14.
Keh D, Trips E, Marx G, Wirtz SP, Abduljawwad E, Bercker S, et al. Effect of hydrocortisone on development of shock among patients with severe sepsis: the HYPRESS randomized clinical trial. Journal of the American Medical Association. 2016;316(17):1775–85.
Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids for treating sepsis. Cochrane Database of Systematic Reviews. 2015;(12).
Confalonieri M, Urbino R, Potena A, et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. American Journal of Respiratory and Critical Care Medicine. 2005;171(3):242–8.
Tongyoo S, Permpikul C, Mongkolpun W, et al. Hydrocortisone treatment in early sepsis-associated acute respiratory distress syndrome: results of a randomized controlled trial. Critical Care Medicine. 2016;20:1–11.
Hoen S, Asehnoune K, Brailly-Tabard S, et al. Cortisol response to corticotropin stimulation in trauma patients: influence of hemorrhagic shock. The Journal of the American Society of Anesthesiologists. 2002;97(4):807–13.
White K, Arlt W. Adrenal crisis in treated Addison’s disease: a predictable but under-managed event. European Journal of Endocrinology. 2010;162(1):115–20.
Hahner S, Loeffler M, Bleicken B, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. European Journal of Endocrinology. 2010;162(3):597–602.
Bancos I, Hahner S, Tomlinson J, et al. Diagnosis and management of adrenal insufficiency. The Lancet Diabetes & Endocrinology. 2015;3(3):216–26.
Oelkers W, Diederich S, Bähr V. Diagnosis and therapy surveillance in Addison’s disease: rapid adrenocorticotropin (ACTH) test and measurement of plasma ACTH, renin activity, and aldosterone. The Journal of Clinical Endocrinology & Metabolism. 1992;75(1):259–64.
Referanslar
Neary N, Nieman L. Adrenal insufficiency-etiology, diagnosis and treatment. Current Opinion in Endocrinology, Diabetes and Obesity. 2010;17(3):217.
Bornstein SR. Predisposing factors for adrenal insufficiency. New England Journal of Medicine. 2009;360(22):2328–39.
Varan Ö, Gürlek A. Adrenal Yetmezlik, Tanı ve Tedavi Algoritması. A Sistemic Review. Yoğun Bakım Dergisi. 2010;9(4):200–7.
Addison T. On the constitutional and local effects of disease of the supura-renal capsules. Highley, London. 1855;
Løvås K, Husebye ES. Replacement therapy for Addison’s disease: recent developments. Expert Opinion Investigational Drugs. 2008;17(4):497–509.
Regal M, Páramo C, Sierra JM, et al. Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clinical Endocrinology. 2001;55(6):735–40.
Woods CP, Argese N, Chapman M, et al. Adrenal suppression in patients taking inhaled glucocorticoids is highly prevalent and management can be guided by morning cortisol. European Journal of Endocrinology. 2015;173(5):633–42.
Bleicken B, Ventz M, Quinkler M, et al. Delayed diagnosis of adrenal insufficiency is common: a cross-sectional study in 216 patients. The American Journal of the Medical Sciences. 2010;339(6):525–31.
Allolio B. Extensive expertise in endocrinology: adrenal crisis. European Journal of Endocrinology. 2015;172(3):R115–24.
Hahner S, Spinnler C, Fassnacht M, et al. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study. The Journal of Clinical Endocrinology & Metabolism. 2015;100(2):407–16.
Rushworth RL, Torpy DJ, Falhammar H. Adrenal crises: perspectives and research directions. Endocrine. 2017;55:336–45.
Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2016;101(2):364–89.
Erichsen MM, Løvås K, Skinningsrud B, et al. Clinical, immunological, and genetic features of autoimmune primary adrenal insufficiency: observations from a Norwegian registry. The Journal of Clinical Endocrinology & Metabolism. 2009;94(12):4882–90.
Dunlop D. Eight-six Cases of Addison’s Disease. British Medical Journal. 1963;2(5362):887.
Hellesen A, Bratland E, Husebye ES. Autoimmune Addison’s disease–An update on pathogenesis. Annales d'Endocrinologie. Elsevier; 2018. p. 157–63.
Afreen B, Khan KA, Riaz A. Adrenal insufficiency in Pakistani HIV infected patients. Journal of Ayub Medical College Abbottabad. 2017;29(3):428–31.
Mofokeng TRP, Beshyah SA, Mahomed F, et al. Significant barriers to diagnosis and management of adrenal insufficiency in Africa. Endocrine Connections. 2020;9(5):445.
Odeniyi IA, Fasanmade OA, Ajala MO, Ohwovoriole AE. Adrenocortical function in Nigerians with human immunodeficiency virus infection. Ghana Medical Journal. 2013;47(4):171.
Laureti S, De Bellis A, Muccitelli VI, et al. Levels of adrenocortical autoantibodies correlate with the degree of adrenal dysfunction in subjects with preclinical Addison’s disease. The Journal of Clinical Endocrinology & Metabolism. 1998;83(10):3507–11.
Betterle C, Dal Pra C, Mantero F, et al. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocrine Reviews. 2002;23(3):327–64.
Chantzichristos D, Persson A, Eliasson B, et al. Incidence, prevalence and seasonal onset variation of Addison’s disease among persons with type 1 diabetes mellitus: nationwide, matched cohort studies. European Journal of Endocrinology. 2018;178(1):113–20.
Herndon J, Nadeau AM, Davidge-Pitts CJ, et al. Primary adrenal insufficiency due to bilateral infiltrative disease. Endocrine. 2018;62:721–8.
Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. The Lancet. 2014;383(9935):2152–67.
Tomlinson JW, Holden N, Hills RK, et al. Association between premature mortality and hypopituitarism. The Lancet. 2001;357(9254):425–31.
Bates AS, Van’t Hoff W, Jones PJ, et al. The effect of hypopituitarism on life expectancy. The Journal of Clinical Endocrinology & Metabolism. 1996;81(3):1169–72.
Appelman-Dijkstra NM, Kokshoorn NE, Dekkers OM, et al. Pituitary dysfunction in adult patients after cranial radiotherapy: systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2011;96(8):2330–40.
Carosi G, Malchiodi E, Ferrante E, et al. Hypothalamic-pituitary axis in non-functioning pituitary adenomas: focus on the prevalence of isolated central hypoadrenalism. Neuroendocrinology. 2015;102(4):267–73.
Jenkins PJ, Bates P, Carson MN, et al, Group UKNARS. Conventional pituitary irradiation is effective in lowering serum growth hormone and insulin-like growth factor-I in patients with acromegaly. The Journal of Clinical Endocrinology & Metabolism. 2006;91(4):1239–45.
Knappe UJ, Petroff D, Quinkler M, et al. Fractionated radiotherapy and radiosurgery in acromegaly: analysis of 352 patients from the German Acromegaly Registry. European Journal of Endocrinology. 2020;182(3):275–84.
Broersen LHA, Pereira AM, Jørgensen JOL, et al. Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2015;100(6):2171–80.
Mebrahtu TF, Morgan AW, Keeley A, et al. Dose dependency of iatrogenic glucocorticoid excess and adrenal insufficiency and mortality: a cohort study in England. The Journal of Clinical Endocrinology & Metabolism. 2019;104(9):3757–67.
Joseph RM, Hunter AL, Ray DW, et al. Systemic glucocorticoid therapy and adrenal insufficiency in adults: a systematic review. Seminars in Arthritis and Rheumatism. Elsevier; 2016. p. 133–41.
Pofi R, Feliciano C, Sbardella E, et al. The short Synacthen (corticotropin) test can be used to predict recovery of hypothalamo-pituitary-adrenal axis function. The Journal of Clinical Endocrinology & Metabolism. 2018;103(8):3050–9.
Selye H. The general adaptation syndrome and the diseases of adaptation. The Journal of Clinical Endocrinology & Metabolism. 1946;6(2):117–230.
Annane D, Sébille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. Journal of the American Medical Association. 2002;288(7):862–71.
Marik PE, Pastores SM, Annane D, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Critical Care Medicine. 2008;36(6):1937–49.
Marik PE, Zaloga GP. Adrenal insufficiency in the critically ill: a new look at an old problem. Chest. 2002;122(5):1784–96.
Garcia-Vidal C, Calbo E, Pascual V, et al. Effects of systemic steroids in patients with severe community-acquired pneumonia. European Respiratory Journal. 2007;30(5):951–6.
Dimopoulou I, Tsagarakis S. Hypothalamic-pituitary dysfunction in critically ill patients with traumatic and nontraumatic brain injury. Applied Physiology in Intensive Care Medicine 2: Physiological Reviews and Editorials. 2012;163–71.
Adrenal ve Gonadal Hastalıklar Çalışma Grubu. Adrenal ve Gonadal Hastalıklar Kılavuzu. Ankara; 2022.
Annane D, Pastores SM, Rochwerg B, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Medicine. 2017;43:1751–63.
Annane D, Maxime V, Ibrahim F, et al. Diagnosis of adrenal insufficiency in severe sepsis and septic shock. American Journal of Respiratory and Critical Care Medicine. 2006;174(12):1319–26.
Jessop DS, Turner-Cobb JM. Measurement and meaning of salivary cortisol: a focus on health and disease in children. Stress. 2008;11(1):1–14.
Marik PE, Zaloga GP. Adrenal insufficiency during septic shock. Critical Care Medicine. 2003;31(1):141–5.
Annane D, Sébille V, Bellissant E, Group GI 05 S. Effect of low doses of corticosteroids in septic shock patients with or without early acute respiratory distress syndrome. Critical Care Medicine. 2006;34(1):22–30.
Ospina NS, Al Nofal A, Bancos I, et al. ACTH stimulation tests for the diagnosis of adrenal insufficiency: systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2016;101(2):427–34.
Ho JT, Al-Musalhi H, Chapman MJ, et al. Septic shock and sepsis: a comparison of total and free plasma cortisol levels. The Journal of Clinical Endocrinology & Metabolism. 2006;91(1):105–14.
Keh D, Trips E, Marx G, Wirtz SP, Abduljawwad E, Bercker S, et al. Effect of hydrocortisone on development of shock among patients with severe sepsis: the HYPRESS randomized clinical trial. Journal of the American Medical Association. 2016;316(17):1775–85.
Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids for treating sepsis. Cochrane Database of Systematic Reviews. 2015;(12).
Confalonieri M, Urbino R, Potena A, et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. American Journal of Respiratory and Critical Care Medicine. 2005;171(3):242–8.
Tongyoo S, Permpikul C, Mongkolpun W, et al. Hydrocortisone treatment in early sepsis-associated acute respiratory distress syndrome: results of a randomized controlled trial. Critical Care Medicine. 2016;20:1–11.
Hoen S, Asehnoune K, Brailly-Tabard S, et al. Cortisol response to corticotropin stimulation in trauma patients: influence of hemorrhagic shock. The Journal of the American Society of Anesthesiologists. 2002;97(4):807–13.
White K, Arlt W. Adrenal crisis in treated Addison’s disease: a predictable but under-managed event. European Journal of Endocrinology. 2010;162(1):115–20.
Hahner S, Loeffler M, Bleicken B, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. European Journal of Endocrinology. 2010;162(3):597–602.
Bancos I, Hahner S, Tomlinson J, et al. Diagnosis and management of adrenal insufficiency. The Lancet Diabetes & Endocrinology. 2015;3(3):216–26.
Oelkers W, Diederich S, Bähr V. Diagnosis and therapy surveillance in Addison’s disease: rapid adrenocorticotropin (ACTH) test and measurement of plasma ACTH, renin activity, and aldosterone. The Journal of Clinical Endocrinology & Metabolism. 1992;75(1):259–64.
