title: Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion].
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.
authors.affiliation: Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoa 814-0180, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yanase
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tajima
authors.forename: Takuyuki
authors.initials: T
authors.lastname: Katabami
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tanahashi
authors.forename: Akira
authors.initials: A
authors.lastname: Sugawara
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Tomoatsu
authors.initials: T
authors.lastname: Mune
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Oki
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Miyamura
authors.forename: Chikara
authors.initials: C
authors.lastname: Shimizu
authors.forename: Michio
authors.initials: M
authors.lastname: Otsuki
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Nomura
authors.forename: Yuko
authors.initials: Y
authors.lastname: Akehi
authors.forename: Makito
authors.initials: M
authors.lastname: Tanabe
authors.forename: Soji
authors.initials: S
authors.lastname: Kasayama
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000628:therapy*; D000324:Adrenocorticotropic Hormone / Q000032:analysis / Q000097:blood; D000328:Adult; D019411:Clinical Laboratory Techniques / Q000379:methods / Q000592:standards; D003346:Corticotropin-Releasing Hormone / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D007564:Japan; D010912:Pituitary-Adrenal Function Tests / Q000379:methods / Q000592:standards; D011247:Pregnancy; D012955:Societies, Medical
chemical_list: D007328:Insulin; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone