Diagnosis and treatment of adrenal insufficiency including adrenal crisis: A japan endocrine society clinical practice guideline

Toshihiko Yanase, Toshihiro Tajima, Takuyuki Katabami, Yasumasa Iwasaki, Yusuke Tanahashi, Akira Sugawara, Tomonobu Hasegawa, Tomoatsu Mune, Yutaka Oki, Yuichi Nakagawa, Nobuhiro Miyamura, Chikara Shimizu, Michio Otsuki, Masatoshi Nomura, Yuko Akehi, Makito Tanabe, Soji Kasayama

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

This clinical practice guideline of the diagnosis and treatment of adrenal insufficiency (AI) including adrenal crisis was produced on behalf of the Japan Endocrine Society. This evidence-based guideline was developed by a committee including all authors, and was reviewed by a subcommittee of the Japan Endocrine Society. The Japanese version has already been published, and the essential points have been summarized in this English language version. We recommend diagnostic tests, including measurement of basal cortisol and ACTH levels in combination with a rapid ACTH (250 μg corticotropin) test, the CRH test, and for particular situations the insulin tolerance test. Cut-off values in basal and peak cortisol levels after the rapid ACTH or CRH tests are proposed based on the assumption that a peak cortisol level ≥18 μg/ dL in the insulin tolerance test indicates normal adrenal function. In adult AI patients, 15-25 mg hydrocortisone (HC) in 2-3 daily doses, depending on adrenal reserve and body weight, is a basic replacement regime for AI. In special situations such as sickness, operations, pregnancy and drug interactions, cautious HC dosing or the correct choice of glucocorticoids is necessary. From long-term treatment, optimal diurnal rhythm and concentration of serum cortisol are important for the prevention of cardiovascular disease and osteoporosis. In maintenance therapy during the growth period of patients with 21-hydroxylase deficiency, proper doses of HC should be used, and long-acting glucocorticoids should not be used. Education and carrying an emergency card are essential for the prevention and rapid treatment of adrenal crisis.

Original languageEnglish
Pages (from-to)765-784
Number of pages20
JournalEndocrine Journal
Volume63
Issue number9
DOIs
Publication statusPublished - Jan 1 2016

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Adrenal Insufficiency
Practice Guidelines
Hydrocortisone
Japan
Adrenocorticotropic Hormone
Therapeutics
Glucocorticoids
Insulin
Circadian Rhythm
Drug Interactions
Routine Diagnostic Tests
Osteoporosis
Emergencies
Cardiovascular Diseases
Language
Body Weight
Guidelines
Education
Pregnancy
Growth

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Yanase, T., Tajima, T., Katabami, T., Iwasaki, Y., Tanahashi, Y., Sugawara, A., ... Kasayama, S. (2016). Diagnosis and treatment of adrenal insufficiency including adrenal crisis: A japan endocrine society clinical practice guideline. Endocrine Journal, 63(9), 765-784. https://doi.org/10.1507/endocrj.EJ16-0242

Diagnosis and treatment of adrenal insufficiency including adrenal crisis : A japan endocrine society clinical practice guideline. / Yanase, Toshihiko; Tajima, Toshihiro; Katabami, Takuyuki; Iwasaki, Yasumasa; Tanahashi, Yusuke; Sugawara, Akira; Hasegawa, Tomonobu; Mune, Tomoatsu; Oki, Yutaka; Nakagawa, Yuichi; Miyamura, Nobuhiro; Shimizu, Chikara; Otsuki, Michio; Nomura, Masatoshi; Akehi, Yuko; Tanabe, Makito; Kasayama, Soji.

In: Endocrine Journal, Vol. 63, No. 9, 01.01.2016, p. 765-784.

Research output: Contribution to journalArticle

Yanase, T, Tajima, T, Katabami, T, Iwasaki, Y, Tanahashi, Y, Sugawara, A, Hasegawa, T, Mune, T, Oki, Y, Nakagawa, Y, Miyamura, N, Shimizu, C, Otsuki, M, Nomura, M, Akehi, Y, Tanabe, M & Kasayama, S 2016, 'Diagnosis and treatment of adrenal insufficiency including adrenal crisis: A japan endocrine society clinical practice guideline', Endocrine Journal, vol. 63, no. 9, pp. 765-784. https://doi.org/10.1507/endocrj.EJ16-0242
Yanase, Toshihiko ; Tajima, Toshihiro ; Katabami, Takuyuki ; Iwasaki, Yasumasa ; Tanahashi, Yusuke ; Sugawara, Akira ; Hasegawa, Tomonobu ; Mune, Tomoatsu ; Oki, Yutaka ; Nakagawa, Yuichi ; Miyamura, Nobuhiro ; Shimizu, Chikara ; Otsuki, Michio ; Nomura, Masatoshi ; Akehi, Yuko ; Tanabe, Makito ; Kasayama, Soji. / Diagnosis and treatment of adrenal insufficiency including adrenal crisis : A japan endocrine society clinical practice guideline. In: Endocrine Journal. 2016 ; Vol. 63, No. 9. pp. 765-784.
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