Replacement Therapies in Adrenal Insufficiency

Auteur

Peter Hindmarsh is a Professor of Pediatric Endocrinology in London, United Kingdom. He has published extensively on cortisol physiology and pharmacology and how these impact on replacement therapies for adrenal insufficiency. He is interested in better delivery of treatment in a more physiological manner as exemplified by the delivery of hydrocortisone using pump therapy to mimic the circadian rhythm.

As the parent of a young adult with Salt Wasting Congenital Adrenal Hyperplasia, Kathy Geertsma became chair of a Congenital Adrenal Hyperplasia Patient, Parent and Carer Information and Support Group known as CAHISUS. She has extensive contact with patients, parents, and carers from all over the world who struggle with confirming the cause for adrenal insufficiency and getting access to proper treatment. As a result, she offers a unique perspective about how practitioners can better serve the needs of their patients.

Texte du rabat
Replacement Therapies in Adrenal Insufficiency provides a thorough understanding of the conditions which result in adrenal insufficiency. Never before has one source of information combined all updates on current causes and mechanisms of adrenal sufficiency to allow for quick reference and subsequent treatment decisions. Scientific data on this broad condition includes specific disease coverage of Addison's disease, hypopituitarism, congenital adrenal hypoplasia and adrenalectomy. Practical points in diagnosis, dosing, drug interactions, replacement therapies and emergency situations are also provided as guidance for overall management.

Contenu

1. Why do we need to get hydrocortisone replacement right?
   
   2. Mortality and morbidity data
   3. Side effects and survey results of quality of life
   4. Oral Glucocorticoid replacement
   5. What is dosing regimen
   6. How to calculate daily dose
   7. How to distribute the dose
   8. Drug interactions including drugs that alter liver metabolism
   9. Specific problems with hormone replacement - oral or transdermal estrogens
   10. Interplay of cortisol and vasopressin - diagnosis of diabetes insipidus and DDAVP replacement
   11. Pituitary replacement that may modify hydrocortisone dosing - thyroxine and growth hormone
   12. Monitoring replacement
   13. What's missing what are we replacing what should we check
   14. Ways of checking 17OHP, ACTH cortisol
   15. Single sample versus multiple samples
   16. Around dose sampling
   17. Effects of OCP
   18. Adjusting doses for events
   19. Illness and the boxes
   20. Stressful events
   21. Surgery
   22. Dental and the boxes
   23. Travel and time zones
   24. Adjustments and effects on other hormones e.g. DDAVP
   25. Glucocorticoid replacement using pump therapy
   26. Pump therapy to mimic circadian rhythm
   27. Principles of the pump
   28. Setting the system up, clearance studies
   29. Monitoring replacement
   30. Quality of life
   31. Managing an Adrenal Crisis
   32. Presentation as new diagnosis or following diagnosis
   33. What it is and what it is not
   34. Biochemical changes
   35. How to manage a crisis - at home, in A&E after admission
   36. Hydrocortisone requirements in a crisis
   37. Glucose requirements during a crisis
   38. Sodium and fluid balance - the importance of subacute or chronic hyponatraemia
   39. Hyperkalaemia
   40. Weaning Glucocorticoids
   41. Factors influencing adrenal suppression dose, type of steroid, how long given, potency and whether given during day or night
   42. The role of alternate day treatments
   43. Principles in weaning
   44. How to wean depending on duration of exposure, disease activity steroid used
   45. What tests to use to determine axis recovery