Diagnostik und Therapie der Nebenniereninsuffizienz

Abstract

Adrenal insufficiency is a potentially life-threatening endocrine disorder. Therefore, it is very important to detect the symptoms in sufficient time and treat effectively to avoid acute adrenal insufficiency. This article provides an insight into diagnostically procedures and therapeutically specific aspects of this rare endocrine disease.

Die primäre oder sekundäre Nebennierenrinden (NNR) -Insuffizienz ist ein potenziell lebensbedrohliches Krankheitsbild. Deshalb ist es wichtig, die Symptome rechtzeitig zu erkennen und durch effektive Therapie eine akute NNR-Krise zu vermeiden. Der vorliegende Beitrag beschreibt das diagnostische Prozedere und die Schwierigkeiten bei der Therapie.

Schlüsselwörter

Nebennierenrindeninsuffizienz - Hydrokortison - Stimulationstest - Patientenschulung

Key words

adrenal insufficiency - hydrocortisone - stimulation test - patient education

• Literatur

• 1 Quinkler M, Beuschlein F, Hahner S. et al. Nebennierenrindeninsuffizienz- lebensbedrohliche Erkrankung mit vielfältigen Ursachen. Dtsch Ärztebl Int 2013; 110: 882-888
• 2 Meyer G, Neumann K, Badenhoop K. et al. Increasing prevalence of Addison´s disease in German females: health insurance data 2008–2012. Eur J Endocrinol 2014; 170: 367-373
• 3 Borresen SW, Klose M, Baslund B. et al. Adrenal insufficiency is seen in more than one-third of patients during ongoing low-dose prednisolone treatment for rheumatoid arthritis. Eur J Endocrinol 2017; 177: 287-295
• 4 Hahner S, Spinnler C, Fassnacht M. et al. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study. J Clin Endocrinol Metab 2015; 100: 407-416
• 5 Fleseriu M, Hashim IA, Karavitaki N. et al. Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101: 3888-3921
• 6 Bornstein SR, Allolio B, Arlt W. et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101: 364-389
• 7 Miljic D, Doknic M, Stojanovic M. et al. Impact of etiology, age and gender on onset and severity of hyponatremia in patients with hypopituitarism: retrospective analysis in a specialised endocrine unit. Endocrine 2017; 58: 312-319
• 8 Harsch IA, Schuller A, Hahn EG. et al. Cortisone replacement therapy in endocrine disorders- quality of self-care. J Eval Clin Pract 2010; 16: 492-498
• 9 Chapman SC, LLahana S, Carroll P. et al. Glucocorticoid therapy for adrenal insufficiency: Nonadherence, concerns and dissatisfaction with information. Clin Endocrinol (Oxf) 2016; 84: 664-671
• 10 Empfehlungen der Sektion Nebenniere, Steroide und Hypertonie der DGE zur HC Anpassung bei medizinischen Eingriffen, Version 8.. Oktober 2016
• 11 Kampmeyer D, Lehnert H, Moenig H. et al. A strong need for improving the education of physicians on glucocorticoid replacement treatment in adrenal insufficiency: An interdisciplinary and multicentre evaluation. Eur J Int Med 2016; 33: e13-e15
• 12 Tiemensma J, Andela CD, Kaptein AA. et al. Psychological morbidity and impaired quality of life in patients with stable treatment for primary adrenal insufficiency: Cross-sectional study and review of the literature. Eur J Endocrinol 2014; 171: 171-182
• 13 Johannsson G, Ragnarsson O. Cardiovascular and metabolic impact of glucocorticoid replacement therapy. Front Horm Res 2014; 43: 33-44
• 14 Bergthorsdottir R, Nilsson AG, Gillberg P. et al. Health-Related Quality of Life in Patients With Adrenal Insufficiency Receiving Plenadren Compared With Immediate-Release Hydrocortisone. Value Health 2015; 18: A616
• 15 Behan LA, Kelleher G, Hannon MJ. et al. Low-dose hydrocortisone replacement therapy is associated with improved bone remodelling balance in hypopituitary male patients. Eur J Endocrinol 2013; 170: 141-150
• 16 Danilowicz K, Bruno OD, Manavela M. et al. Correction of cortisol overreplacement ameliorates morbidities in patients with hypopituitarism: a pilot study. Pituitary 2008; 11: 279-285
• 17 Johannsson G, Nilsson AG, Bergthorsdottir R. et al. Improved cortisol exposure-time profile and outcome in patients with adrenal insufficiency: a prospective randomized trial of a novel hydrocortisone dual-release formulation. J Clin Endocrinol Metab 2012; 97: 473-481
• 18 Quinkler M, Miodini Nilsen R, Zopf K. et al. Modified-release hydrocortisone decreases BMI and HbA1c in patients with primary and secondary adrenal insufficiency. Eur J Endocrinol 2015; 172: 619-626
• 19 Guarnotta V, Ciresi A, Pillitteri G. et al. Improved insulin sensitivity and secretion in prediabetic patients with adrenal insuffiiency on dual-release hydrocortisone treatment: a 36-month retrospective analysis. Clin Endocrinol (Oxf) 2018; 88 (05) 665-672
• 20 Giordano R, Guaraldi F, Marinazzo E. et al. Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison’s disease. Endocrine 2016; 51: 360-368
• 21 Mallappa A, Sinaii N, Kumar P. et al. A phase 2 study of Chronocort, a modified-relewase formulatio of hydrocortisone, in the treatment of adults with classic congenital adrenal hyperplasia. J Clin Endocrinol Metab 2015; 100: 1137-1145