The Experts below are selected from a list of 8721 Experts worldwide ranked by ideXlab platform
Olaf M Dekkers - One of the best experts on this subject based on the ideXlab platform.
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management of endocrine disease glucocorticoid induced Adrenal Insufficiency replace while we wait for evidence
European Journal of Endocrinology, 2021Co-Authors: Kristina Laugesen, Leonie H A Broersen, Olaf M Dekkers, Simon Boggild Hansen, Henrik Toft Sorensen, Jens Otto Lunde JorgensenAbstract:Glucocorticoids are, besides non-steroidal anti-inflammatory drugs, the most widely used anti-inflammatory medications. Prevalence studies indicate substantial use of both systemic and locally acting agents. A recognised adverse effect of glucocorticoid treatment is Adrenal Insufficiency, which is highly prevalent based on biochemical testing, but its clinical implications are poorly understood. Current evidence, including randomised trials and observational studies, indicates substantial variation among patients in both risk and course of glucocorticoid-induced Adrenal Insufficiency, but both are currently unpredictable. Oral and intra-articular formulations, as well as long-term and high-dose treatments, carry the highest risk of glucocorticoid-induced Adrenal Insufficiency defined by biochemical tests. However, no route of administration, treatment duration, or dose can be considered without risk. More research is needed to estimate the risk and temporal pattern of glucocorticoid-induced Adrenal Insufficiency, to investigate its clinical implications, and to identify predictors of risk and prognosis. Randomized trials are required to evaluate whether hydrocortisone replacement therapy mitigates risk and symptoms of glucocorticoid-induced Adrenal Insufficiency in patients discontinuing glucocorticoid treatment. This review aims to provide an overview of the available evidence, pointing to knowledge gaps and unmet needs.
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Adrenal Insufficiency in corticosteroids use systematic review and meta analysis
The Journal of Clinical Endocrinology and Metabolism, 2015Co-Authors: Leonie H A Broersen, Alberto M Pereira, Jens Otto Lunde Jorgensen, Olaf M DekkersAbstract:Objective: We aimed to estimate pooled percentages of patients with Adrenal Insufficiency after treatment with corticosteroids for various conditions in a meta-analysis. Secondly, we aimed to stratify the results by route of administration, disease, treatment dose, and duration. Methods: We searched seven electronic databases (PubMed, MEDLINE, EMBASE, COCHRANE, CENTRAL, Web of Science, and CINAHL/Academic Search Premier) in February 2014 to identify potentially relevant studies. Original articles testing adult corticosteroid users for Adrenal Insufficiency were eligible. Results: We included 74 articles with a total of 3753 participants. Stratified by administration form, percentages of patients with Adrenal Insufficiency ranged from 4.2% for nasal administration (95% confidence interval [CI], 0.5–28.9) to 52.2% for intra-articular administration (95% CI, 40.5–63.6). Stratified by disease, percentages ranged from 6.8% for asthma with inhalation corticosteroids only (95% CI, 3.8–12.0) to 60.0% for hematolo...
Jens Otto Lunde Jorgensen - One of the best experts on this subject based on the ideXlab platform.
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management of endocrine disease glucocorticoid induced Adrenal Insufficiency replace while we wait for evidence
European Journal of Endocrinology, 2021Co-Authors: Kristina Laugesen, Leonie H A Broersen, Olaf M Dekkers, Simon Boggild Hansen, Henrik Toft Sorensen, Jens Otto Lunde JorgensenAbstract:Glucocorticoids are, besides non-steroidal anti-inflammatory drugs, the most widely used anti-inflammatory medications. Prevalence studies indicate substantial use of both systemic and locally acting agents. A recognised adverse effect of glucocorticoid treatment is Adrenal Insufficiency, which is highly prevalent based on biochemical testing, but its clinical implications are poorly understood. Current evidence, including randomised trials and observational studies, indicates substantial variation among patients in both risk and course of glucocorticoid-induced Adrenal Insufficiency, but both are currently unpredictable. Oral and intra-articular formulations, as well as long-term and high-dose treatments, carry the highest risk of glucocorticoid-induced Adrenal Insufficiency defined by biochemical tests. However, no route of administration, treatment duration, or dose can be considered without risk. More research is needed to estimate the risk and temporal pattern of glucocorticoid-induced Adrenal Insufficiency, to investigate its clinical implications, and to identify predictors of risk and prognosis. Randomized trials are required to evaluate whether hydrocortisone replacement therapy mitigates risk and symptoms of glucocorticoid-induced Adrenal Insufficiency in patients discontinuing glucocorticoid treatment. This review aims to provide an overview of the available evidence, pointing to knowledge gaps and unmet needs.
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Adrenal Insufficiency in corticosteroids use systematic review and meta analysis
The Journal of Clinical Endocrinology and Metabolism, 2015Co-Authors: Leonie H A Broersen, Alberto M Pereira, Jens Otto Lunde Jorgensen, Olaf M DekkersAbstract:Objective: We aimed to estimate pooled percentages of patients with Adrenal Insufficiency after treatment with corticosteroids for various conditions in a meta-analysis. Secondly, we aimed to stratify the results by route of administration, disease, treatment dose, and duration. Methods: We searched seven electronic databases (PubMed, MEDLINE, EMBASE, COCHRANE, CENTRAL, Web of Science, and CINAHL/Academic Search Premier) in February 2014 to identify potentially relevant studies. Original articles testing adult corticosteroid users for Adrenal Insufficiency were eligible. Results: We included 74 articles with a total of 3753 participants. Stratified by administration form, percentages of patients with Adrenal Insufficiency ranged from 4.2% for nasal administration (95% confidence interval [CI], 0.5–28.9) to 52.2% for intra-articular administration (95% CI, 40.5–63.6). Stratified by disease, percentages ranged from 6.8% for asthma with inhalation corticosteroids only (95% CI, 3.8–12.0) to 60.0% for hematolo...
Giuseppe Delitala - One of the best experts on this subject based on the ideXlab platform.
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primary symptomatic Adrenal Insufficiency induced by megestrol acetate
Netherlands Journal of Medicine, 2013Co-Authors: Alessandro P Delitala, Giuseppe Fanciulli, Margherita Maioli, G Piga, Giuseppe DelitalaAbstract:Megestrol acetate (MA) is a progestational agent for the treatment of metastatic breast cancer and endometrial cancer. MA has also been used to promote weight gain in malnourished elderly patients, in patients with immunodeficiency virus and in cancer-induced cachexia. In addition to thromboembolic disease, MA may induce hyperglycaemia, osteoporosis, suppression of the gonadal axis, and Cushing's syndrome. MA has also been shown to cause symptomatic suppression of the hypothalamic-pituitary-Adrenal (HPA) axis owing to its intrinsic glucocorticoid-like effect. Three additional patients are presented who developed symptomatic Adrenal Insufficiency while they were receiving 160-320 mg MA daily. The patients were treated with cortisone acetate supplements, had clear evidence of HPA-axis suppression but recovered fully after MA was discontinued. Patients receiving MA might have an inadequate Adrenal response during stressful conditions, possibly because 160-320 mg MA daily may not provide adequate protection to prevent the symptoms of Adrenal Insufficiency. The adverse MA effect on the HPA axis is probably not well recognised in clinical practice, and clinicians need an increased awareness of the endocrine complications secondary to MA treatment.
Kristian Lovas - One of the best experts on this subject based on the ideXlab platform.
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optimal glucocorticoid replacement in Adrenal Insufficiency
Best Practice & Research Clinical Endocrinology & Metabolism, 2015Co-Authors: Marianne Oksnes, Richard Ross, Kristian LovasAbstract:Adrenal Insufficiency (glucocorticoid deficiency) comprises a group of rare diseases, including primary Adrenal Insufficiency, secondary Adrenal Insufficiency and congenital Adrenal hyperplasia. Lifesaving glucocorticoid therapy was introduced over 60 years ago, but since then a number of advances in treatment have taken place. Specifically, little is known about short- and long-term treatment effects, and morbidity and mortality. Over the past decade, systematic cohort and registry studies have described reduced health-related quality of life, an unfavourable metabolic profile and increased mortality in patients with Adrenal Insufficiency, which may relate to unphysiological glucocorticoid replacement. This has led to the development of new modes of replacement that aim to mimic normal glucocorticoid physiology. Here, evidence for the inadequacy of conventional glucocorticoid therapy and recent developments in treatment are reviewed, with an emphasis on primary Adrenal Insufficiency.
Javier D Finkielman - One of the best experts on this subject based on the ideXlab platform.
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the incidence of relative Adrenal Insufficiency in patients with septic shock after the administration of etomidate
Critical Care, 2006Co-Authors: Zulfiqar Mohammad, Bekele Afessa, Javier D FinkielmanAbstract:Introduction Etomidate blocks adrenocortical synthesis when it is administered intravenously as a continuous infusion or a single bolus. The influence of etomidate administration on the incidence of relative Adrenal Insufficiency in patients with septic shock has not been formally investigated. The objective of this study was to determine the incidence of relative Adrenal Insufficiency in patients with septic shock after etomidate administration compared with patients with septic shock who did not receive etomidate.