Surrenal Yetersizlik

Year 2008, Volume: 8 Issue: 3, 145 - 151, 01.07.2008

Hülya Günöz

Abstract

Adrenal yetersizlik göreceli olarak çocukluk ve ergenlik döneminde nadirdir, primer ve sekonder, konjenital ve edinsel olarak gruplandırılabilir. Primer adrenal yetersizlik nedenleri arasında konjenital adrenal hiperplazi, otoimmün adrenal yetersizlik, Wolman, triple A, Zellweger gibi bazı sendromlar sayılabilir. Sekonder adrenal yetersizliğe ise glukokortikoid tedavinin kesilmesi, adrenal süpresyon durumunda stres ortaya çıkması ve primer ACTH eksikliğine bağlı ortaya çıkabilir. Glukokortikoid ve mineralokortikoid yerine koyma tedavisi gereklidir. Adrenal kriz adrenal yetersizliği olan çocuklarda hastalıklar sırasında yetersiz glukokortikoid tedaviye bağlı olarak ortaya çıkabilir. Adrenal yetersizliğin erken tanınması ve tedavi edilmesi önemlidir. Adrenal krizin önlenmesi için sağlık görevlilerine ve ailelere öneriler yapılmalıdır.

Keywords

Surrenal yetersizlik, çocuk, glukokortikoid

Adrenal Insufficiency

Abstract

Adrenal insufficiency is relatively rare in childhood and adolescence, and may be categorized as primary or secondary and congenital or acquired. Primary adrenal insufficiency causes include congenital adrenal hyperplasia, autoimmune adrenal insufficiency, adrenoleucodystrophy, syndromes Wolman, triple A, Zellweger, etc. . Secondary adrenal insufficiency may occur due to discontinuation of glucocorticoid therapy or stress on suppressive doses, deficiency primary ACTH. Glucocorticoid and mineralocorticoid replacement therapy are necessary. If unrecognized, adrenal insufficiency may present with life-threatening cardiovascular collapse. Adrenal crisis continues to occur in children with adrenal insufficiency during acute disease because of failure to increase glucocorticoid dose. Early recognition and treatment of adrenal insufficiency are most important. Suggestions for prevention of adrenal crisis in patients at risk are provided for families and health care professionals.

Keywords

Adrenal insufficiency, childhood, glucocorticoid

References

• 1. Arlt W, Alloli OB. Adrenal insufficiency: Lancet 2003; 361:1881-93.
• 2. Arlt W. Management of adrenal insufficiency, In: ENDO, 2004, New Orleans. Meet the Professor Handout Endocrine Society Pres, 2004: 171-6.
• 3. Dickstein G. Evaluation of adrenal function in the ICU and elsewhere, In: ENDO 2008, San Francisco, Meet the Professor Handouts, Endocrin Society Pres 2008: 21-8.
• 4. Levine LS. Congenital adrenal hyperplasia. Pediatric Review 2000; 21:159-70.
• 5. Merke DP. Born stein SR: Congenital adrenal hyperplasia. Lancet 2005: 365:2125-36.
• 6. Migeon CJ, Lanes RL. Adrenal cortex: Hypo hyperfunction. In: Pediatric Endocrinology, ed: F. Lifshitz; 5th ed. Vol: 2. Marcel Dekker, New York, 2007: 195-226.
• 7. Root AW, Shulmann DI. Clinical adrenal disorders. In: Pediatric Endocrinology Mechanisms, Manifestations and Management Eds OH Pescovitz, EA Eugster, 1st ed. Lippincott, Williams Wilkins, Philadelphia, 2004: 568-600.
• 8. Salvatori R. Adrenal insufficiency: JAMA 2005; 294:2481-8.
• 9. Stor HL, Savage MO, Clark AJL. Advances in the unders- tanding of the genetic basis of adrenal insufficiency. J Pediatr Endocrinol Metabol 2002; 15:1323-8.
• 10. Ten S, New M, Maclaren N. Clinical Review 130, Addison disease. J Clin Endocrinol Metab 2001: 86:2909-22.
• 11. White PC. Disorders of adrenal gland. In: Nelson Textbook of Pediatrics, 18 th edition: Saunders Philadelphia 2007: 2349- 75.