Dtsch Med Wochenschr 2022; 147(03): 98-106
DOI: 10.1055/a-1370-5874
Dossier

Nebennieren-Erkrankungen: Morbus Addison

Adrenal gland diseases: Addison’s Disease
Irina Chifu
,
Stefanie Hahner

Der Morbus Addison entsteht v. a. infolge einer autoimmun bedingten Destruktion der Nebennierenrinde und ist durch ein Defizit aller Nebennierenhormone charakterisiert. Im Gegensatz zu vielfältigen iatrogenen Ursachen der Nebenniereninsuffizienz (NNI) handelt es sich um eine seltene, oft lange unerkannte Erkrankung. Dieser Artikel gibt einen Überblick über den Morbus Addison und auch über für andere Formen der NNI relevante Aspekte des klinischen Managements.

Abstract

Addison’s disease typically results from the autoimmune destruction of the adrenal cortex and requires lifelong replacement with glucocorticoids and mineralocorticoids. Main symptoms are non-specific and, therefore, often overlooked or misleading. Patients are frequently not diagnosed until experiencing a life-threatening adrenal crisis. This article highlights the essential clinical characteristics, diagnostic aspects and principles of management of adrenal insufficiency.



Publikationsverlauf

Artikel online veröffentlicht:
31. Januar 2022

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  • Literatur

  • 1 Pearce JMS. Thomas Addison (1793–1860). J R Soc Med 2004; 97: 297-300
  • 2 Bancos I, Hahner S, Tomlinson J. et al. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol 2015; 3: 216-226
  • 3 Ho W, Druce M. Quality of life in patients with adrenal disease: A systematic review. Clin Endocrinol (Oxf) 2018; 89: 119-128
  • 4 Bergthorsdottir R, Leonsson-Zachrisson M, Odén A. et al. Premature Mortality in Patients with Addison’s Disease: A Population-Based Study. J Clin Endocrinol Metab 2006; 91: 4849-4853
  • 5 Skov J, Sundstrom A, Ludvigsson JF. et al. Sex-Specific Risk of Cardiovascular Disease in Autoimmune Addison Disease-A Population-Based Cohort Study. J Clin Endocrinol Metab 2019; 104: 2031-2040
  • 6 Hahner S, Spinnler C, Fassnacht M. et al. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study. J Clin Endocrinol Metab 2015; 100: 407-416
  • 7 Kalafatakis K, Russell GM, Harmer CJ. et al. Ultradian rhythmicity of plasma cortisol is necessary for normal emotional and cognitive responses in man. Proc Natl Acad Sci U S A 2018; 115: E4091
  • 8 Hahner S, Ross RJ, Arlt W. et al. Adrenal insufficiency. Nat Rev Dis Primers 2021; 7: 19
  • 9 de Filette J, Andreescu CE, Cools F. et al. A Systematic Review and Meta-Analysis of Endocrine-Related Adverse Events Associated with Immune Checkpoint Inhibitors. Horm Metab Res 2019; 51: 145-156
  • 10 Grouthier V, Lebrun-Vignes B, Moey M. et al. Immune Checkpoint Inhibitor-Associated Primary Adrenal Insufficiency: WHO VigiBase Report Analysis. Oncologist 2020; 25: 696-701
  • 11 Bornstein SR, Allolio B, Arlt W. et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101: 364-389
  • 12 Guarnotta V, Di Stefano C, Santoro A. et al. Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency. Endocr Connect 2019; 8: 853-862
  • 13 Quinkler M, Miodini Nilsen R, Zopf K. et al. Modified-release hydrocortisone decreases BMI and HbA1c in patients with primary and secondary adrenal insufficiency. Eur J Endocrinol 2015; 172: 619-626
  • 14 Johannsson G, Bergthorsdottir R, Nilsson AG. et al. Improving glucocorticoid replacement therapy using a novel modified-release hydrocortisone tablet: a pharmacokinetic study. Eur J Endocrinol 2009; 161: 119-130
  • 15 Bannon CAM, Border D, Hanson P. et al. Early Metabolic Benefits of Switching Hydrocortisone to Modified Release Hydrocortisone in Adult Adrenal Insufficiency. Front Endocrinol (Lausanne) 2021; 12: 641247
  • 16 Isidori AM, Venneri MA, Graziadio C. et al. Effect of once-daily, modified-release hydrocortisone versus standard glucocorticoid therapy on metabolism and innate immunity in patients with adrenal insufficiency (DREAM): a single-blind, randomised controlled trial. Lancet Diabetes Endocrinol 2018; 6: 173-185
  • 17 Dineen R, Martin-Grace J, Ahmed KMS. et al. Cardiometabolic and psychological effects of dual-release hydrocortisone: a cross-over study. Eur J Endocrinol 2021; 184: 253-265
  • 18 Løvås K, Gebre-Medhin G, Trovik TS. et al. Replacement of dehydroepiandrosterone in adrenal failure: no benefit for subjective health status and sexuality in a 9-month, randomized, parallel group clinical trial. J Clin Endocrinol Metab 2003; 88: 1112-1118
  • 19 Gurnell EM, Hunt PJ, Curran SE. et al. Long-term DHEA replacement in primary adrenal insufficiency: a randomized, controlled trial. J Clin Endocrinol Metab 2008; 93: 400-409
  • 20 Rushworth RL, Torpy DJ, Falhammar H. Adrenal Crisis. N Engl J Med 2019; 381: 852-861