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Teaches AI patients about stress-dosing and emergency glucocorticoid administration; instructs to obtain emergency card/bracelet/necklace and kit with injectable high-dose GC. Triggers when counseling any patient with adrenal insufficiency (e.g., "Use when…
لغة النص الأصلي: الإنجليزية
Recommends adjusting glucocorticoid doses on the day of surgery based on illness severity and magnitude of surgical stress. Triggers when managing a patient requiring surgery needing perioperative glucocorticoid management, such as "patient on HC for central…
لغة النص الأصلي: الإنجليزية
Recommends measurement of plasma ACTH to establish primary adrenal insufficiency (PAI) diagnosis in patients with confirmed cortisol deficiency; a plasma ACTH concentration ≥2-fold the upper limit of the reference range supports PAI. Use when evaluating…
لغة النص الأصلي: الإنجليزية
This skill suggests initiating antihypertensive treatment while continuing fludrocortisone when blood pressure remains uncontrolled after fludrocortisone dose reduction. Trigger phrases include "BP remains uncontrolled," "persistent hypertension," or…
لغة النص الأصلي: الإنجليزية
The Endocrine Society guideline recommends against routine hormonal monitoring of glucocorticoid replacement in primary adrenal insufficiency and advises adjusting therapy solely based on clinical response. Use when evaluating glucocorticoid dose adequacy,…
لغة النص الأصلي: الإنجليزية
Suggests adjusting glucocorticoid dose according to severity of illness or magnitude of the stressor in patients with primary adrenal insufficiency. Use when patient with PAI has intercurrent illness, fever, or stress.
لغة النص الأصلي: الإنجليزية
Suggests using hydrocortisone 15–25 mg or cortisone acetate 20–35 mg daily in two or three divided oral doses for adult primary adrenal insufficiency (PAI) patients initiating glucocorticoid replacement. The highest dose is given upon awakening, with the…
لغة النص الأصلي: الإنجليزية
This skill suggests using prednisolone as an alternative glucocorticoid when hydrocortisone is unavailable for emergency treatment of adrenal crisis. Dexamethasone is the least-preferred option and should only be administered if no other glucocorticoid is…
لغة النص الأصلي: الإنجليزية
This skill guides annual evaluation of patients with primary adrenal insufficiency (PAI) for symptoms and signs of glucocorticoid and mineralocorticoid over- or under-replacement. Use during annual follow-up when assessing for weight changes, blood pressure…
لغة النص الأصلي: الإنجليزية
Suggests periodic screening for autoimmune diseases known to be more prevalent in PAI patients in whom autoimmune origin of PAI has not been excluded; optimal frequency unknown but can be done annually. Use when determining screening schedule for PAI patient…
لغة النص الأصلي: الإنجليزية
Recommends against dexamethasone for glucocorticoid replacement in primary adrenal insufficiency (PAI) due to risk of Cushingoid side effects from difficult dose titration. Use when selecting a glucocorticoid for PAI management to avoid iatrogenic Cushing…
لغة النص الأصلي: الإنجليزية
Suggests avoiding synthetic, long-acting glucocorticoids (e.g., prednisolone, dexamethasone) in children with primary adrenal insufficiency (PAI). Use when selecting glucocorticoid replacement for a child with PAI to prevent Cushingoid side effects and dose…
لغة النص الأصلي: الإنجليزية
Recommends confirmatory testing with corticotropin stimulation test in patients presenting with clinical symptoms or signs suggesting PAI (e.g., fatigue, hypotension, hyponatremia, hyperpigmentation) when the patient's condition permits safe testing. Use when…
لغة النص الأصلي: الإنجليزية
Initiates a 6‑month trial of DHEA replacement in women with primary adrenal insufficiency (PAI) who have persistent low libido, depressive symptoms, or low energy despite otherwise optimized glucocorticoid and mineralocorticoid therapy. If the patient does…
لغة النص الأصلي: الإنجليزية
Suggests a trial of dehydroepiandrosterone (DHEA) replacement in women with primary adrenal insufficiency (PAI) who report low libido, depressive symptoms, and/or low energy levels despite otherwise optimized glucocorticoid and mineralocorticoid replacement.…
لغة النص الأصلي: الإنجليزية
This skill outlines the emergency management of suspected adrenal crisis, recommending immediate parenteral hydrocortisone (100 mg adult, 50 mg/m² pediatric) plus fluid resuscitation, then 200 mg/24 h (50–100 mg/m²/24 h pediatric) hydrocortisone. Trigger when…
لغة النص الأصلي: الإنجليزية
Recommends immediate IV hydrocortisone stress dosing for patients with suspected adrenal crisis presenting with severe adrenal insufficiency symptoms such as hypotension, hyponatremia, hyperkalemia, or acute abdominal pain. Use when clinician observes signs…
لغة النص الأصلي: الإنجليزية
Recommends initiating fludrocortisone 50–100 µg daily for mineralocorticoid replacement in adults with confirmed aldosterone deficiency (e.g., low aldosterone, elevated renin) and no salt restriction. Use when aldosterone deficiency is confirmed in a patient…
لغة النص الأصلي: الإنجليزية
Determines follow‑up interval for patients with primary adrenal insufficiency (PAI) based on age: annual visits for adults and children, and every 3–4 months for infants. Triggered when establishing routine endocrine care after PAI diagnosis or during stable…
لغة النص الأصلي: الإنجليزية
Suggests genetic counseling for patients with primary adrenal insufficiency (PAI) when a monogenic disorder is suspected. Use when PAI patient presents with early-onset disease, syndromic features, consanguinity, family history, or negative autoimmune…
لغة النص الأصلي: الإنجليزية
Recommends equipping every patient with primary adrenal insufficiency (PAI) with a glucocorticoid injection kit for emergency self‑administration and providing training on its use. Trigger when preparing a PAI patient for stress dosing, adrenal crisis…
لغة النص الأصلي: الإنجليزية
Recommends initiating glucocorticoid therapy in all patients with confirmed primary adrenal insufficiency (PAI). Use when PAI diagnosis is confirmed by subnormal cortisol response to ACTH stimulation test or elevated ACTH with low cortisol.
لغة النص الأصلي: الإنجليزية
Recommends increasing hydrocortisone dose in pregnant patients with primary adrenal insufficiency based on individual clinical course, especially during the third trimester. Trigger phrases include "fatigue, postural hypotension, weight loss, or hyperglycemia…
لغة النص الأصلي: الإنجليزية
Suggests using a low-dose (1 µg) corticotropin stimulation test to diagnose primary adrenal insufficiency when the standard 250 µg corticotropin is unavailable due to drug shortage. Consider this approach when clinicians encounter a corticotropin shortage or…
لغة النص الأصلي: الإنجليزية
Suggests monitoring DHEA replacement in women with primary adrenal insufficiency (PAI) by measuring morning serum DHEAS levels before the daily dose, targeting the mid‑normal range. Consider when evaluating low libido, depressive symptoms, or low energy…
لغة النص الأصلي: الإنجليزية
Monitors glucocorticoid replacement in primary adrenal insufficiency (PAI) patients using clinical assessment of body weight, postural blood pressure, energy levels, and signs of frank glucocorticoid excess. Trigger phrases include "PAI patient on…
لغة النص الأصلي: الإنجليزية
This skill outlines monitoring of mineralocorticoid replacement in primary adrenal insufficiency, focusing on clinical assessment of salt craving, postural hypotension, or edema alongside serum electrolyte measurements. It is initiated when evaluating…
لغة النص الأصلي: الإنجليزية
This skill outlines monitoring glucocorticoid replacement in children with primary adrenal insufficiency (PAI) using clinical assessment of growth velocity, weight, blood pressure, and energy levels. Trigger when evaluating a child with PAI for adequacy of…
لغة النص الأصلي: الإنجليزية
Suggests that pregnant patients with primary adrenal insufficiency be monitored for clinical signs of glucocorticoid over- or under-replacement such as normal weight or gain, fatigue, postural hypotension or hypertension, and hyperglycemia, with at least one…
لغة النص الأصلي: الإنجليزية
Educates patients with primary adrenal insufficiency on increasing glucocorticoid dosage during intercurrent illness, fever (≥38°C), or physiological stress, including recognition of precipitating symptoms (e.g., fever, vomiting, trauma) and actions to…
لغة النص الأصلي: الإنجليزية
Recommends fludrocortisone 100 µg daily for children with primary adrenal insufficiency and confirmed aldosterone deficiency; for infants under 12 months, adds sodium chloride supplementation. Triggered by PAI with aldosterone deficiency, evidenced by salt…
لغة النص الأصلي: الإنجليزية
Recommends initiating hydrocortisone replacement at a total starting dose of 8 mg/m2 body surface area per day, given in three or four divided doses, for children with confirmed primary adrenal insufficiency (PAI). Use when starting glucocorticoid therapy in…
لغة النص الأصلي: الإنجليزية
Suggests using prednisolone 3–5 mg/d orally once or twice daily as a glucocorticoid alternative in primary adrenal insufficiency. Consider this option when evaluating glucocorticoid therapy, particularly in patients with reduced medication compliance.
لغة النص الأصلي: الإنجليزية
In pregnant women with primary adrenal insufficiency (PAI), the guideline suggests using hydrocortisone over cortisone acetate, prednisolone, or prednisone for glucocorticoid replacement. It recommends against dexamethasone due to its lack of placental…
لغة النص الأصلي: الإنجليزية
Suggests using morning cortisol ≤140 nmol/L (5 µg/dL) in combination with ACTH as a preliminary test suggestive of primary adrenal insufficiency when a corticotropin stimulation test is not feasible. Use when patients present with indicative symptoms such as…
لغة النص الأصلي: الإنجليزية
Suggests reducing the fludrocortisone dose in patients who develop new-onset hypertension while on fludrocortisone replacement for primary adrenal insufficiency. Consider dose reduction when hypertension arises alongside signs of mineralocorticoid excess such…
لغة النص الأصلي: الإنجليزية
This skill recommends simultaneous measurement of plasma renin and aldosterone in patients with primary adrenal insufficiency (PAI) to determine the presence of mineralocorticoid deficiency. It is triggered when assessing for mineralocorticoid deficiency in…
لغة النص الأصلي: الإنجليزية
The Endocrine Society recommends a standard-dose corticotropin (ACTH) stimulation test to confirm primary adrenal insufficiency when clinical suspicion arises from symptoms such as hypotension, hyponatremia, hyperkalemia, or unexplained fatigue. Dosing is…
لغة النص الأصلي: الإنجليزية
Recommends hydrocortisone stress dosing during the active phase of labor for pregnant patients with primary adrenal insufficiency, using a regimen similar to major surgical stress. Trigger phrases: "active phase of labor", "cervix dilation ≥4 cm",…
لغة النص الأصلي: الإنجليزية
Recommends diagnostic testing to exclude primary adrenal insufficiency (PAI) in acutely ill patients presenting with otherwise unexplained volume depletion, hypotension, hyponatremia, hyperkalemia, fever, abdominal pain, hyperpigmentation, or hypoglycemia…
لغة النص الأصلي: الإنجليزية