Clinical Review#: The diagnosis and management of central hypoadrenalism.
BACKGROUND
Adrenal failure secondary to hypothalamo-pituitary disease is a common clinical problem which has serious repercussions. It is essential to perform validated diagnostic procedures and manage such patients with clear objectives and based on well-established replacement programs.


METHODS
PubMed was searched for all data reflecting pituitary hypoadrenalism dating back to 1960 in order to establish a published database.


RESULTS
The results from published studies were assessed in the light of the author's extensive personal experience dating back some 30 yr in clinical endocrinology, in an attempt to provide clear diagnostic and management advice.


CONCLUSIONS
While much of the physiology of the hypothalamo-pituitary-adrenal axis is well understood, its clinical assessment and diagnostic procedures to establish the need for replacement are still far from perfect, and to a certain extent clinical judgement is still vital. In terms of replacement therapies, these are still far from optimal in terms of quality of life and mortality, although they are increasingly being based on objective evidence rather than established practice. However, it is anticipated that newer replacement protocols will improve a situation that has previously changed little for many years.
Grossman
Ashley B
AB
Barts and the London School of Medicine, London, United Kingdom. A.B.Grossman@qmul.ac.uk
D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*
D005938:Glucocorticoids