#AACE2021: Top 20-Approach to Patient with Adrenal Insufficiency

Video Transcription

Video Summary

Dr. Richard Aukas gave a lecture on the approach to a patient with adrenal insufficiency. He discussed the prevalence and incidence of adrenal insufficiency, highlighting that it is a rare disease. He emphasized that adrenal insufficiency is often misdiagnosed by non-endocrinologists. The most common cause is autoimmune, and patients may have positive 21-hydroxylase antibodies. Dr. Aukas also discussed the diagnostic testing for adrenal insufficiency, including the cosentropin stimulation test and measuring cortisol and ACTH levels. He explained the importance of clinical evaluation in combination with laboratory tests to make a diagnosis. Dr. Aukas discussed the various causes of adrenal insufficiency, including infections, infiltrative diseases, genetics, and medications such as glucocorticoids and narcotics. He also highlighted the potential for adrenal crisis, especially in cases of infection, and discussed the precipitants and symptoms of adrenal crisis. Dr. Aukas provided guidance on the management of adrenal insufficiency, including steroid replacement therapy and monitoring of electrolytes, blood pressure, and clinical symptoms. He also touched on the use of modified release hydrocortisone preparations and continuous subcutaneous infusions of hydrocortisone. Finally, he discussed the management of adrenal insufficiency during pregnancy and in critically ill patients, as well as addressing common questions and concerns regarding the diagnosis and management of adrenal insufficiency.

Asset Subtitle

Richard J. Auchus, MD, PhD, FACE

Keywords

adrenal insufficiency

diagnostic testing

autoimmune

21-hydroxylase antibodies

adrenal crisis

management

steroid replacement therapy

electrolytes

blood pressure

diagnosis