DIAGNOSIS OF ADRENAL INSUFFICIENCY INDUCED BY GLUCOCORTICOIDS

• DOI: 10.22533/at.ed.1593732313091

• Palavras-chave: Adrenal insufficiency. Glucocorticoids. Diagnosis.

• Keywords: Adrenal insufficiency. Glucocorticoids. Diagnosis.

• Abstract:

  Adrenal Insufficiency (AI) corresponds to the inability of the adrenal gland to produce adequate amounts of adrenocortical hormones and can be caused by prolonged use of glucocorticoids. In these cases, despite the rarity of this etiology, the presentation of patients with shock or hypotension, together with non-specific and potentially fatal symptoms, characterizes a clinical emergency. Due to the severity of this problem, the objective of the study was to review the literature regarding adrenal insufficiency, in order to choose the best diagnostic approach for patients using glucocorticoids. The methodology was an integrative review of the literature, searching for the descriptors “adrenal insufficiency”, “diagnosis” and “glucocorticoids" in the MEDLINE and LILACS databases, selecting filters for English and Portuguese. From publications carried out between 2018 and 2023, five works were chosen for study. As a result of the research, it was observed that diagnostic procedures for adrenal insufficiency induced by glucocorticoids imply the correct collection of the clinical history, focusing on the symptoms and medications used or that were suspended without guidance Furthermore, this etiology demonstrated the greatest number of symptoms, such as fatigue, skin hyperpigmentation and weight loss. Body mass index and waist circumference were higher when compared to primary adrenal insufficiency, however the best clinical indicators of adequate replacement of glucocorticoids were the symptoms reported by the patient, such as appetite and well-being. In children, the approach is similar, accompanied by periodic dose adjustment. And, regarding complementary exams, the rapid stimulation test with ACTH, followed by serum cortisol measurement is the gold standard, other dosages help to differentiate the etiologies. Finally, careful collection of clinical history, physical examination and complementary tests are vital to confirm the diagnosis of adrenal insufficiency and avoid negative outcomes.