Medicinski pregled 2017 Volume 70, Issue 11-12, Pages: 465-471
https://doi.org/10.2298/MPNS1712465B
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Glucocorticoid therapy and adrenal suppression
Benc Damir (Clinical Center of Vojvodina, Department of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad + Faculty of Medicine Novi Sad2)
Ičin Tijana (Clinical Center of Vojvodina, Department of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad + Faculty of Medicine Novi Sad2)
Pejaković Slađana (Clinical Center of Vojvodina, Department of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad + Faculty of Medicine Novi Sad2)
Bajkin Ivana (Clinical Center of Vojvodina, Department of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad + Faculty of Medicine Novi Sad2)
Prodanović Jovana (Clinical Center of Vojvodina, Department of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad)
Vuković Bojan (Clinical Center of Vojvodina, Department of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad + Faculty of Medicine Novi Sad2)
Novaković-Paro Jovanka (Clinical Center of Vojvodina, Department of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad + Faculty of Medicine Novi Sad2)
Tomić-Naglić Dragana (Clinical Center of Vojvodina, Department of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad + Faculty of Medicine Novi Sad2)
Zvezdin Biljana (Faculty of Medicine, Novi Sad + Institute of Pulmonary Diseases of Vojvodina, Novi Sad)
Mitrović Milena (Clinical Center of Vojvodina, Department of Endocrinology, Diabetes and Metabolic Diseases, Novi Sad + Faculty of Medicine Novi Sad2)
Introduction. Adrenal insufficiency results from the inadequate
adrenocortical conjunction. Adrenal insufficiency can be primary, secondary
and tertiary one. The most common cause of adrenal suppression is the effect
of exogenous therapy with glucocorticoids. Glucocorticoids. Corticosteroids
are used in treatment of endocrine and non-endocrine diseases. They are
applied as a substitution therapy in the patients with primary and secondary
adrenal insufficiency. Due to their immunosuppressive and anti-inflammatory
characteristics, they are used to treat a wide range of diseases. They are
usually divided according to the length and size of the effect i.e. how they
are applied. Adrenal Insufficiency. Glucocorticoid therapy may lead to a
number of adverse effects such as a disorder in glucose metabolism,
osteoporosis or frequent infections. Adrenal suppression is the most common
complication resulting from corticosteroid application. The function of the
hypothalamus-pituitary-adrenal axis may be inhibited for months after the
treatment cessation. There are several predictors of potential
glucocorticoid-induced adrenal suppression. Diagnosing Adrenal
Insufficiency. The most frequent symptoms and signs of adrenal insufficiency
are fatigue, nausea and vomiting, hyponatremia, hyperpigmentation or
hypotension. Algorithm for the diagnosis of adrenal insufficiency must be
followed in clinical practice. Reduction in Glucocorticoid Therapy.
Reduction or complete cessation of the therapy is indicated when the
maximum therapeutic benefit has been achieved or when considerable side
effects, such as diabetes mellitus, severe hypertension, osteoporosis i.e.
adrenal insufficiency, develop. Conclusion. Numerous synthetic
glucocorticoids have been developed to be used in everyday clinical practice
and they can be administered systemically or locally. A lot of side effects
are associated with chronic administration of glucocorticoids. In order to
avoid complications, it is recommended to administer intermediate-acting
glucocorticoids every second day. In addition, the patients must be
monitored carefully and glucocorticoid therapy should be discontinued
gradually to prevent adrenal insufficiency or reactivation of the disease
under therapy.
Keywords: Glucocorticoids, Adrenal Insufficiency, Drug-Related Side Effects and Adverse Reactions, Diagnosis, Signs and Symptoms, Hydrocortisone