Evaluation of Pituitary‐adrenocortical Function in Patients With Rheumatoid Arthritis Following Steroid Therapy*

Meakin, J. W.; Tantongco, Maria S.; Crabbé, J.; Bayles, Theodore B.; Nelson, Don H.

doi:10.1111/j.1749-6632.1960.tb42866.x

Cited by 9 publications

(2 citation statements)

References 21 publications

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“…During the process of recovery from HPA suppression, physiological circadian secretion of cortisol may recover before return of the ability of the hypothalamus to respond to stress 19. Therefore, a patient may have a normal 8:00 AM cortisol, but still be unable to show an appropriate serum cortisol response to stress 20 21. The wide variability in timing of recovery of the HPA axis after discontinuation of glucocorticoid exposure emphasizes the need for clinicians to be aware of clinical scenarios with an increased risk of AI.…”

Section: Etiologymentioning

confidence: 99%

“…19 Therefore, a patient may have a normal 8:00 AM cortisol, but still be unable to show an appropriate serum cortisol response to stress. 20 21 The wide variability in timing of recovery of the HPA axis after discontinuation of glucocorticoid exposure emphasizes the need for clinicians to be aware of clinical scenarios with an increased risk of AI.…”

Section: Etiologymentioning

confidence: 99%

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Emergency Management of Adrenal Insufficiency in Children: Advocating for Treatment Options in Outpatient and Field Settings

Miller

Spencer

Geffner

et al. 2020

Journal of Investigative Medicine

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Adrenal insufficiency (AI) remains a significant cause of morbidity and mortality in children with 1 in 200 episodes of adrenal crisis resulting in death. The goal of this working group of the Pediatric Endocrine Society Drug and Therapeutics Committee was to raise awareness on the importance of early recognition of AI, to advocate for the availability of hydrocortisone sodium succinate (HSS) on emergency medical service (EMS) ambulances or allow EMS personnel to administer patient’s HSS home supply to avoid delay in administration of life-saving stress dosing, and to provide guidance on the emergency management of children in adrenal crisis. Currently, hydrocortisone, or an equivalent synthetic glucocorticoid, is not available on most ambulances for emergency stress dose administration by EMS personnel to a child in adrenal crisis. At the same time, many States have regulations preventing the use of patient’s home HSS supply to be used to treat acute adrenal crisis. In children with known AI, parents and care providers must be made familiar with the administration of maintenance and stress dose glucocorticoid therapy to prevent adrenal crises. Patients with known AI and their families should be provided an Adrenal Insufficiency Action Plan, including stress hydrocortisone dose (both oral and intramuscular/intravenous) to be provided immediately to EMS providers and triage personnel in urgent care and emergency departments. Advocacy efforts to increase the availability of stress dose HSS during EMS transport care and add HSS to weight-based dosing tapes are highly encouraged.

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Section: Etiologymentioning

confidence: 99%