Increased Cardiovascular Risk in Patients with Adrenal Insufficiency: A Short Review.

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Term Occurence Count Dictionary
fludrocortisone 2 endocrinologydiseasesdrugs
metabolic syndrome 1 endocrinologydiseases
mitotane 1 endocrinologydiseasesdrugs
obesity 3 endocrinologydiseases
adrenal insufficiency 7 endocrinologydiseases
cortisol 20 endocrinologydiseasesdrugs
dexamethasone 2 endocrinologydiseasesdrugs
diabetes mellitus 2 endocrinologydiseases

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Select Drug Character Offset Drug Term Instance
cortisol 762 Patients with AI receive glucocorticoid (GC) replacement therapy which can lead to varying levels of blood cortisol . It was shown that these imbalances in blood cortisol may lead to a higher prevalence of coronary heart
cortisol 816 therapy which can lead to varying levels of blood cortisol. It was shown that these imbalances in blood cortisol may lead to a higher prevalence of coronary heart disease, major adverse coronary events, and increased
cortisol 1526 differences in the renin-angiotensin-aldosterone system (RAAS). Furthermore, decreased blood levels of cortisol may lead to a compensatory secretion of inflammatory mediators such as Interleukin-1 (IL-1), Interleukin-6
cortisol 3614 used GC substitution formula in both primary and secondary AI. Of note, HC corresponds to endogenous cortisol in regard to bioavailability and receptor affinity [[11]]. During the last years, a once-daily oral
cortisol 5661 monitoring the effectiveness of hydrocortisone replacement therapy seems to be a challenge. While urinary cortisol excretion has been shown to be helpful in the diagnostic approach to hypercortisolism, significant interindividual
cortisol 5744 challenge. While urinary cortisol excretion has been shown to be helpful in the diagnostic approach to hyper cortisol ism, significant interindividual variations in both primary and secondary AI do not favour this method
cortisol 5862 significant interindividual variations in both primary and secondary AI do not favour this method in hypo cortisol ism [[21]]. Salivary cortisol measurements have been in use for more than 50 years and may present a
cortisol 5891 variations in both primary and secondary AI do not favour this method in hypocortisolism [[21]]. Salivary cortisol measurements have been in use for more than 50 years and may present a suitable monitoring parameter
cortisol 6677 Replacement TherapyCurrent GC replacement regimens try to mimic the physiological rhythm of endogenous cortisol as accurately as possible. However, temporary supra- and subphysiological levels of blood cortisol are
cortisol 6776 cortisol as accurately as possible. However, temporary supra- and subphysiological levels of blood cortisol are common and may be harmful. In fact, patients with AI on GC replacement therapy appear to have an
cortisol 7601 Cushing's disease suffering from these symptoms due to an ACTH-producing tumor in the pituitary gland or a cortisol secreting tumor in the adrenal gland. Exogenous GC therapy may result in similar clinical manifestations
cortisol 11480 at all [[8]].5. Inflammatory MarkersAnother conceivable option to study CVR in AI is temporary hypo cortisol ism and subsequent increase of inflammatory markers such as Interleukin 1 (IL-1), Interleukin 6 (IL-6),
cortisol 11678 Interleukin 6 (IL-6), and tumor-necrosis factor (TNF). Mastorakos et al. showed a correlation between blood cortisol levels and these inflammatory mediators [[39]].In another study by Papanicolaou et al. from 1996 IL-1,
cortisol 11913 measured multiple times in patients with Cushing's disease before and after surgery [[40]]. While blood cortisol levels were reduced to hypocortisolemic levels on the fourth and fifth postoperative day, a significant
cortisol 11949 Cushing's disease before and after surgery [[40]]. While blood cortisol levels were reduced to hypo cortisol emic levels on the fourth and fifth postoperative day, a significant rise of circulating IL-6 was seen.
cortisol 12339 volunteers led to a significant reduction of corticosteroid-binding globulin and a rise of free blood cortisol [[41], [42]].A collaborative meta-analysis from 2012 by Sarwar and Butterworth showed a slight risk
cortisol 12926 beneficial effect on coronary heart disease [[44]].Overall, these studies indicate a correlation between cortisol and proinflammatory mediators such as IL-1, IL-6, and TNF, with these markers being associated with
cortisol 14025 over the past decades. While current replacement regimens try to mimic the physiological secretion of cortisol as accurately as possible, there is still a lot of room for improvement. Similar to insulin therapy
cortisol 14309 serious side effects while guaranteeing an adequate substitution of the deficient hormone. New synthetic cortisol formulas introduced in recent years with a delayed-release may deliver better therapeutic options. Previous
cortisol 14714 these new glucocorticoid substitution formulas may also avoid temporary subphysiological levels of cortisol . Further studies on this subject are required to improve patient care and outcome in adrenal insufficiency.Table
dexamethasone 3815 once-daily oral HC dual-release tablet was developed [[12]]. Other common formulas include prednisolone and dexamethasone , although the use of the latter has been advised against by the current guideline on primary AI by the
dexamethasone 11348 [[38]]. Prednisolone, for example, shows lower affinity to the MC receptors than hydrocortisone while dexamethasone shows no MC effect at all [[8]].5. Inflammatory MarkersAnother conceivable option to study CVR in AI
fludrocortisone 4232 per day in both primary and secondary AI, divided into two or three doses [[8], [14]]. Furthermore, fludrocortisone is given to patients with primary AI demonstrating low levels of aldosterone at a dose of 100 μg/d
fludrocortisone 10519 insufficiency may include an absence of mineralocorticoids (MC) resulting in a need for daily substitution of fludrocortisone at a recommended dose of 100 μg/d [[8]]. Overreplacement may lead to arterial hypertension and electrolyte
mitotane 2239 associated adrenalitis remains an important cause in developing countries [[4], [5]]. Certain drugs such as mitotane , ketoconazole, metyrapone, and etomidate may lead to primary adrenal insufficiency due to their inhibiting
Select Disease Character Offset Disease Term Instance
adrenal insufficiency 587 (CVD) is the most common cause of death in the world. Recent studies have shown an association between adrenal insufficiency (AI) and increased cardiovascular risk (CVR). Patients with AI receive glucocorticoid (GC) replacement
adrenal insufficiency 1840 about the increased risk of CVD in patients with AI.1. Adrenal Insufficiency: General OverviewPrimary adrenal insufficiency (AI) is a rare disease with a prevalence of approximately 100 to 126 cases per million in Western countries
adrenal insufficiency 2309 [[4], [5]]. Certain drugs such as mitotane, ketoconazole, metyrapone, and etomidate may lead to primary adrenal insufficiency due to their inhibiting effect on adrenal enzymes [[6]]. ACTH-deficiency in the pituitary gland results
adrenal insufficiency 8843 showed no significant discrepancy when comparing healthy subjects with patients suffering from primary adrenal insufficiency receiving hydrocortisone replacement therapy, therefore suggesting no increased CVR in regard to lipid
adrenal insufficiency 10401 subjects appeared to be unaffected [[36]].4. Mineralocorticoid Replacement in Adrenal InsufficiencyPrimary adrenal insufficiency may include an absence of mineralocorticoids (MC) resulting in a need for daily substitution of fludrocortisone
adrenal insufficiency 13192 ConclusionsWhile analysing past studies regarding the topic of cardiovascular risk in patients with adrenal insufficiency this reviewer recognizes a strong need for patient education in regard to not only the underlying disease
adrenal insufficiency 14808 levels of cortisol. Further studies on this subject are required to improve patient care and outcome in adrenal insufficiency .Table 1Use of oral glucocorticoids (GC) and cardiovascular or cerebrovascular events, stratified according
diabetes mellitus 13408 underlying disease itself but also a risk reduction of known factors such as obesity, high blood pressure, diabetes mellitus , and hyperlipidaemia. Patients should be informed about the increased risk for cardiovascular events
diabetes mellitus 14137 accurately as possible, there is still a lot of room for improvement. Similar to insulin therapy in diabetes mellitus , GC replacement therapy should focus on avoiding serious side effects while guaranteeing an adequate
metabolic syndrome 10105 increased cardiovascular mortality associated with higher GC doses [[35]]. When comparing the prevalence of metabolic syndrome between male and female hypopituitary patients and healthy controls, Khang et al. showed an increased
obesity 1309 GC such as prednisolone is also in use. Overreplacement of GC may lead to adverse effects including obesity , high blood pressure, and hyperglycaemia. Outcome may vary between primary and secondary AI mainly due
obesity 7383 therapy affects some of the well-known risk factors for cardiovascular disease (CVD), for example, obesity , hypertension, diabetes, and hyperlipoproteinemia [[26]–[29]]. This can be observed in patients with
obesity 13378 regard to not only the underlying disease itself but also a risk reduction of known factors such as obesity , high blood pressure, diabetes mellitus, and hyperlipidaemia. Patients should be informed about the

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