1. Adrenal insufficiency in systematic lupus erythematosus (SLE) and antiphospholipid syndrome (APS): A systematic review
- Author
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Na Eun Kim, Joo Yeon Lee, Jong Min Kim, Jee Hoon Kim, Se Seung Kim, Dong Ha Kim, Jin Yeong Kim, Soogeun Shin, Dong Hyun Shin, Jae Il Shin, Hansung Kang, Andreas Kronbichler, Won Suk Rho, Joo Sang Song, Hyun Jeong Lee, Yong Seok Lee, Nam Soo Kim, Keum Hwa Lee, Dongkwan Shin, So Hyun Moon, Jung Dong Kim, Cheol hun Lee, Seungmin Jeong, and In Sung Hwang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Abdominal pain ,Adolescent ,Nausea ,Fludrocortisone ,Immunology ,Young Adult ,Antiphospholipid syndrome ,Internal medicine ,Adrenal insufficiency ,medicine ,Immunology and Allergy ,Humans ,Lupus Erythematosus, Systemic ,Child ,Aged ,Aged, 80 and over ,Lupus erythematosus ,medicine.diagnostic_test ,business.industry ,ACTH stimulation test ,Middle Aged ,medicine.disease ,Antiphospholipid Syndrome ,Prednisolone ,Female ,medicine.symptom ,business ,medicine.drug ,Adrenal Insufficiency - Abstract
Background Adrenal insufficiency (AI) is associated with high morbidity and mortality. The aim of this systematic review was to enhance diagnostic approaches and summarize therapeutic strategies in the management of AI in patients with systematic lupus erythematosus (SLE) or antiphospholipid syndrome (APS). Methods A literature search of PubMed and Medline databases was performed and 91 publications containing 105 cases were included for the final analysis. Results The following frequency of clinical signs and symptoms was noted: abdominal pain (39.04%) was the leading symptom, followed by fever (33.33%), vomiting (23.81%), and nausea (19.05%). APS was present in 73%, SLE in 17% of the patients, while 2% had a diagnosis of both, SLE and APS. ACTH stimulation test (ACTHst) was performed in 18% of cases and 76.6% of them were unresponsive towards stimulation. Variable treatment approaches were used: hydrocortisone was most commonly used (38.09%), followed by fludrocortisone (26.67%), prednisolone (20.00%) and volume replacement treatment (11.43%), respectively. Conclusions This analysis highlights the importance of an early diagnosis and initiation of therapeutic management when AI is suspected. In line, signs and symptoms related to autoimmune diseases in patients with AI should be reviewed crtitically.
- Published
- 2018