Pruebas dinámicas en endocrinología: insuficiencia adrenal

  • Clara Arango Toro Hospital Pablo Tobón Uribe, Universidad de Antioquia
  • Germán Campuzano Maya Laboratorio Clínico Hematológico, Universidad de Antioquia
  • Guillermo Latorre Sierra Universidad de Antioquia
Palabras clave: insuficiencia adrenal, cortisol, hormona adrenocorticotrópica (ACTH), hormona liberadora de corticotropina (CRH), prueba de tolerancia a la insulina, prueba de estímulo con metirapona, prueba de estímulo con cosintropina.

Resumen

El diagnóstico de insuficiencia adrenal se sospecha con los hallazgos clínicos en el paciente, pero sólo se confirma con las pruebas de laboratorio. La insuficiencia adrenal primaria es causada por una lesión en la glándula adrenal, en tanto que la insuficiencia adrenal secundaria puede ser causada por enfermedad hipotalámica o hipofisaria, o como resultado de la supresión del eje hipotálamo-hipófisis-adrenal por esteroides. Los hallazgos clínicos de insuficiencia adrenal primaria incluyen fatiga, anorexia, diarrea, dolores osteomusculares e hiperpigmentación, entre otros. Los hallazgos clínicos de la insuficiencia adrenal secundaria son similares; sin embargo, no se presenta hiperpigmentación. Es común que el clínico se enfrente a un paciente con síntomas inespecíficos y no considere la posibilidad de un diagnóstico de insuficiencia adrenal. Una prueba de tamización ideal debe ser de bajo costo, fácil y segura; infortunadamente, hasta el momento, no se dispone de una prueba ideal para la insuficiencia adrenal. La determinación del cortisol basal es una prueba que se utiliza comúnmente para la tamización, que puede incluir (si es <3 μg/dL o <5 μg/dL, de acuerdo con diferentes autores) o excluir (si es >18 μg/dL) una insuficiencia adrenal; sin embargo, la mayoría de los pacientes tendrán un valor intermedio y por ello se harán necesarias las pruebas dinámicas. En el presente módulo se revisan las pruebas dinámicas en el estudio de la insuficiencia adrenal, incluyendo la prueba de tolerancia a la insulina, la prueba de estímulo con metirapona y la prueba de estímulo con cosintropina, como agentes inductores de la producción de cortisol. Finalmente, se presenta un algoritmo para el estudio del paciente con sospecha de insuficiencia adrenal.

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Biografía del autor/a

Clara Arango Toro, Hospital Pablo Tobón Uribe, Universidad de Antioquia

Médica especialista en Medicina Interna y Endocrinología. Docente Medicina Interna, Universidad de Antioquia. Médica Internista, Hospital Pablo Tobón Uribe. Calle 78B No. 69-240. Medellín, Colombia.

Germán Campuzano Maya, Laboratorio Clínico Hematológico, Universidad de Antioquia

Médico especialista en Hematología y Patología Clínica. Docente, Ad Honorem, Facultad de Medicina, Universidad de Antioquia. Médico Director, Laboratorio Clínico Hematológico. Carrera 43C No. 5-33, Medellín, Colombia.

Guillermo Latorre Sierra, Universidad de Antioquia

Médico especialista en Medicina Interna y Endocrinología. Docente Endocrinología Clínica y Metabolismo, Jefe de la Sección de Endocrinología y Metabolismo. Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

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Cómo citar
1.
Arango Toro C, Campuzano Maya G, Latorre Sierra G. Pruebas dinámicas en endocrinología: insuficiencia adrenal. Med. Lab. [Internet]. 1 de mayo de 2009 [citado 8 de diciembre de 2021];15(5-6):211-32. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/421
Publicado
2009-05-01
Sección
La Clínica y el Laboratorio

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