MANAGEMENT OF ENDOCRINE DISEASE: Glucocorticoid-induced adrenal insufficiency: replace while we wait for evidence?

Glucocorticoids are, besides non-steroidal anti-inflammatory drugs, the most widely used anti-inflammatory medications. Prevalence studies indicate substantial use of both systemic and locally acting agents. A recognised adverse effect of glucocorticoid treatment is adrenal insufficiency, which is highly prevalent based on biochemical testing, but its clinical implications are poorly understood. Current evidence, including randomised trials and observational studies, indicates substantial variation among patients in both risk and course of glucocorticoid-induced adrenal insufficiency, but both are currently unpredictable. Oral and intra-articular formulations, as well as long-term and high-dose treatments, carry the highest risk of glucocorticoid-induced adrenal insufficiency defined by biochemical tests. However, no route of administration, treatment duration, or dose can be considered without risk. More research is needed to estimate the risk and temporal pattern of glucocorticoid-induced adrenal insufficiency, to investigate its clinical implications, and to identify predictors of risk and prognosis. Randomized trials are required to evaluate whether hydrocortisone replacement therapy mitigates risk and symptoms of glucocorticoid-induced adrenal insufficiency in patients discontinuing glucocorticoid treatment. This review aims to provide an overview of the available evidence, pointing to knowledge gaps and unmet needs.

[Management of antipsychotic-induced metabolic side effects].

Antipsychotics are associated with significant weight gain and other metabolic side effects. There are, however, substantial differences in their propensity for causing metabolic side effects as summarised in this review. These differences are important to consider when deciding which antipsychotic to use. Given the risk of metabolic side effects, patients should be closely monitored regarding anthropometric measures and metabolic parameters. Moreover, both non-pharmacological and pharmacological interventions should be considered for treatment of antipsychotic-induced weight gain.

[Prevalence of methicillin resistant Staphylococcus aureus is increasing in Danish farming]. / Prævalensen af methicillinresistente Staphylococcus aureus er stigende i dansk landbrug.

Since 2001 livestock-associated methicillin resistant Staphylococcus aureus (LA-MRSA) has increased in Denmark. Transmission to people happens by contact with livestock and mainly pigs. The prevalence in animals is not known but the bacterial reservoir is huge. The incidence of human isolates is increasing. However, LA-MRSA seems to be less virulent than non-LA-MRSA. Well-designed studies focusing on LA-MRSA infection, carrier status and risk factors in populations at risk are needed in order to provide solid data of the health consequences due to this rural, mainly occupational exposure.