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Adrenal insufficiency in systematic lupus erythematosus (SLE) and antiphospholipid syndrome (APS): A systematic review

Authors
 Keum Hwa Lee  ;  HyunJeong Lee  ;  Cheol-hun Lee  ;  Jin Yeong Kim  ;  Jong Min Kim  ;  Se Seung Kim  ;  Seungmin Jeong  ;  In Sung Hwang  ;  Namsoo Kim  ;  Na Eun Kim  ;  Soogeun Shin  ;  Dongkwan Shin  ;  Joo Sang Song  ;  Dong Hyun Shin  ;  Jung Dong Kim  ;  Jeehoon Kim  ;  Yong Seok Lee  ;  Hansung Kang  ;  Dong Ha Kim  ;  So Hyun Moon  ;  Won Suk Rho  ;  Joo Yeon Lee  ;  Andreas Kronbichler  ;  Jae Il Shin 
Citation
 Autoimmunity Reviews, Vol.18(1) : 1-8, 2019 
Journal Title
 Autoimmunity Reviews 
ISSN
 1568-9972 
Issue Date
2019
Keywords
Adrenal insufficiency (AI) ; Antiphospholipid syndrome (APS) ; Systematic review ; autoimmune disease ; systematic lupus erythematosus (SLE)
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.
Full Text
https://www.sciencedirect.com/science/article/pii/S1568997218302520
DOI
10.1016/j.autrev.2018.06.014
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
Yonsei Authors
신재일(Shin, Jae Il) ORCID logo https://orcid.org/0000-0003-2326-1820
이금화(Lee, Keum Hwa) ORCID logo https://orcid.org/0000-0002-1511-9587
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/167340
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