オオツキ　ミチオ   Michio Otsuki   大月　道夫    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	総説
言語種別	英語
査読の有無	査読あり
表題	Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]
掲載誌名	正式名：Endocrine Journal 略　 称：Endocr J ISSNコード：09188959
掲載区分	国内
巻・号・頁	63(9),pp.765-784
著者・共著者	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.
発行年月	2016
概要	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 mug 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 mug/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.
DOI	10.1507/endocrj.EJ16-0242
文献番号	27350721