The exact impact of inclusion of X-linked adrenoleukodystrophy on the uniform newborn screening panel cannot be completely predicted, but based on the information that we already have, we can estimate it will have a significant impact on the acute and sometimes catastrophic effects of adrenal insufficiency
and will reduce the numbers of boys with ALD who are ineligible for the life- saving therapy of bone marrow transplantation because they are identified at a time when the brain disease is too advanced.
Clinical features of adrenal insufficiency
may include extreme weakness, fatigue, myalgia, altered mental status, hypotension, hyponatremia, hypoglycemia, headache, anorexia, nausea, and vomiting (Aron et al.
In primary adrenal insufficiency
, ACTH is invariably high before the morning dose and rapidly declines with increasing cortisol levels after glucocorticoid ingestion (11).
in patients with AIDS: when to suspect it and how to diagnose it.
Therapeutically DHEA might be useful for improving psychological well-being in the elderly, reducing disease activity in people with mild to moderate systemic lupus erythematosus and myotonic dystrophy, improving mood in those clinically depressed, and improving various parameters in women with adrenal insufficiency
After comparison of IL-6 levels and response to ACTH-stimulation they concluded that IL-6 might be a major player in the alteration of the pituitary-adrenal axis leading to relative adrenal insufficiency
Other recent research from 2007 has found celiac disease linked with increased risk of adrenal insufficiency
, pancreatitis, liver disease, sarcoidosis and non-affective psychosis.
may occur after transfer from systemic to inhaled aerosol steroids.
6-16[micro]g/dl) received hydrocortisone replacement only if they had symptoms of adrenal insufficiency
(AI) or during stress; while patients with [greater than or equal to] 450 nmol/l ([less than or equal to] 16.
As a result of recent evidence that even a single bolus dose of etomidate may suppress adrenal cortical function, leading to a relative adrenal insufficiency
(AI), (1-6) there has been extensive debate in the recent literature, with numerous editorials discussing the safety of etomidate (Hypnomidate; Janssen SA) in patients requiring a rapid-sequence intubation (RSI).
In their latest October 2007 Guidelines for Perinatal Care, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics advise that "repeated corticosteroid courses should not be used routinely because clinical trials show decreased brain size, decreased birth weight, and adrenal insufficiency
in neonates exposed to repeated doses.
An article published in CLINICAL PSYCHIATRY NEWS ("Beware of Adrenal Insufficiency
With Atypicals," December 2007, p.