Doctors, teach your adrenal insufficiency patients well: provide them with a European Emergency Card!

Beun, Johan G.; Burman, Pia; Kämpe, Olle; Husebye, Eystein S.; Hahner, Stefanie; Kristensen, Jette Kolding; Noordzij, Alida; Dahlqvist, Per

doi:10.1530/ec-22-0345

Cited by 4 publications

(1 citation statement)

References 8 publications

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“…Therefore, a careful clinical follow-up is suggested to prevent a thyroid storm. In the authors’ opinion, since endocrine levels are not able to predict the development of a thyroid storm, an effort to increase the awareness of patients to recognize early signs/symptoms of decompensation should be conducted, as in the early management of an Addisonian crisis [ 26 ]. Moreover, in order to reduce the gap between patients and Healthcare Providers, a dedicated e-mail address and a facility for teleconsultation may reduce the risk that unconsidered thyrotoxicosis can evolve into a thyroid storm [ 27 ].…”

Section: Clinical Presentation and Management Of Severe Hyperthyroidismmentioning

confidence: 99%

Therapeutic Plasma Exchange for the Treatment of Hyperthyroidism: Approach to the Patient with Thyrotoxicosis or Antithyroid-Drugs Induced Agranulocytosis

Tizianel

Sabbadin

Censi

et al. 2023

JPM

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Primary hyperthyroidism is an endocrine disorder characterized by excessive thyroid hormone synthesis and secretion by the thyroid gland. Clinical manifestations of hyperthyroidism can vary from subclinical to overt forms. In rare cases, hyperthyroidism may represent a clinical emergency, requiring admission to an intensive care unit due to an acute and severe exacerbation of thyrotoxicosis, known as a thyroid storm. First-line treatment of hyperthyroidism is almost always based on medical therapy (with thioamides, beta-adrenergic blocking agents, glucocorticoids), radioactive iodine or total thyroidectomy, tailored to the patient’s diagnosis. In cases of failure/intolerance/adverse events or contraindication to these therapies, as well as in life-threatening situations, including a thyroid storm, it is necessary to consider an alternative treatment with extracorporeal systems, such as therapeutic plasma exchange (TPE). This approach can promptly resolve severe conditions by removing circulating thyroid hormones. Here we described two different applications of TPE in clinical practice: the first case is an example of thyrotoxicosis due to amiodarone treatment, while the second one is an example of a severe adverse event to antithyroid drugs (agranulocytosis induced by methimazole).

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Section: Clinical Presentation and Management Of Severe Hyperthyroidismmentioning

confidence: 99%

Therapeutic Plasma Exchange for the Treatment of Hyperthyroidism: Approach to the Patient with Thyrotoxicosis or Antithyroid-Drugs Induced Agranulocytosis

Tizianel

Sabbadin

Censi

et al. 2023

JPM

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Extensive expertise in endocrinology: adrenal crisis in assisted reproduction and pregnancy

Feldt-Rasmussen

2024

European Journal of Endocrinology

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Appropriate management of adrenal insufficiency in pregnancy is challenging due to the rarity of both primary, secondary and tertiary forms of the disease as well as the lack of evidence-based recommendations to guide clinicians to glucocorticoid and sometimes also mineralocorticoid dosage adjustments. Debut of adrenal insufficiency during pregnancy requires immediate diagnosis as it can lead to adrenal crisis, intrauterine growth restriction and foetal demise. Diagnosis is difficult due to overlap of symptoms of adrenal insufficiency and its crisis with those of pregnancy. Adrenal insufficiency in stable replacement treatment needs careful monitoring during pregnancy to adapt to the physiological changes in the requirement of the adrenal hormones. This is hampered because the diagnostic threshold of most adrenocortical hormones is not applicable during pregnancy. The frequent use of assisted reproduction technology with controlled ovarian hyperstimulation in these patient groups with disease induced low fertility has created an unrecognised risk of adrenal crises due to accelerated oestrogen stimulation with increased risk of even be life-threatening complications for both the woman and foetus. The area needs consensus recommendations between gynaecologists and endocrinologists in tertiary referral centres to alleviate such increased gestational risk. Patient and partner education, use of the EU emergency card for management of adrenal crises can also contribute to better pregnancy outcomes. There is a strong need of more research on e.g. improvement of glucocorticoid replacement as well as crisis management treatment, and biomarkers for treatment optimisation in this field, which suffers from the rare nature of the diseases and poor funding.

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The multiple faces of autoimmune Addison’s disease in children

Capalbo,

Esposito,

Gaeta

et al. 2024

Front. Endocrinol.

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Primary adrenal insufficiency (PAI) is a rare medical condition, characterized by a deficiency in adrenal hormones. Although rare, PAI is a life-threatening disease requiring prompt recognition and treatment. However, symptoms of PAI are often non-specific and diagnosis can be challenging, causing frequent diagnostic delays. In adults, autoimmunity is the most common cause of PAI in industrialized countries, whereas in children, the most frequent etiology is represented by congenital defects of steroidogenesis and, in particular, by congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. A few recent case series from different countries have reported that autoimmunity is the second most common etiology of PAI in the pediatric age group. However, data on autoimmune PAI in children are still scant and the exact epidemiology, clinical manifestations, and long-term outcomes of this condition have yet to be defined. The scope of this review is to summarize the current knowledge on the etiology, presentation, and treatment of autoimmune PAI in childhood and to increase physicians’ awareness of the signs that should raise an early suspicion of this condition.

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Doctors, teach your adrenal insufficiency patients well: provide them with a European Emergency Card!

Cited by 4 publications

References 8 publications

Therapeutic Plasma Exchange for the Treatment of Hyperthyroidism: Approach to the Patient with Thyrotoxicosis or Antithyroid-Drugs Induced Agranulocytosis

Therapeutic Plasma Exchange for the Treatment of Hyperthyroidism: Approach to the Patient with Thyrotoxicosis or Antithyroid-Drugs Induced Agranulocytosis

Extensive expertise in endocrinology: adrenal crisis in assisted reproduction and pregnancy

The multiple faces of autoimmune Addison’s disease in children

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