[
    {
        "page": 1,
        "title": "Insuficiencia Suprarrenal",
        "body": "<p>\n\n\n<meta http-equiv=\"Content-Type\" content=\"text\/html; charset=utf-8\" \/>\n<meta name=\"ProgId\" content=\"Word.DocumentW\" \/>\n<meta name=\"Generator\" content=\"Microsoft Word 15\" \/>\n<meta name=\"Originator\" content=\"Microsoft Word 15\" \/>\n<link rel=\"File-List\n\" href=\"file:\/\/\/C:\/Users\/lucas\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_filelist.xml\" \/>\n<link rel=\"themeData\n\" href=\"file:\/\/\/C:\/Users\/lucas\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_themedata.thmx\" \/>\n<link rel=\"colorSchemeMapping\n\" href=\"file:\/\/\/C:\/Users\/lucas\/AppData\/Local\/Temp\/msohtmlclip1\/01\/clip_colorschememapping.xml\" \/>\n<xml>\n \n  \n  \n   \n   \n   \n   \n   \n   \n   \n   \n   \n  \n  \n  \n   \n   \n   \n   \n   \n   \n   \n   \n   \n   \n   \n  \n<\/xml><xml>\n \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n \n<\/xml>\n<style>\n\n<\/style>\n\n<style>\n \/* Style Definitions *\/\n table.MsoNormalTable\n\t{mso-style-name:\"Tabla normal\";\n\tmso-tstyle-rowband-size:0;\n\tmso-tstyle-colband-size:0;\n\tmso-style-noshow:yes;\n\tmso-style-priority:99;\n\tmso-style-parent:\"\";\n\tmso-padding-alt:0cm 5.4pt 0cm 5.4pt;\n\tmso-para-margin:0cm;\n\tmso-pagination:none;\n\ttext-autospace:none;\n\tfont-size:11.0pt;\n\tfont-family:\"Calibri\",sans-serif;\n\tmso-ascii-font-family:Calibri;\n\tmso-ascii-theme-font:minor-latin;\n\tmso-hansi-font-family:Calibri;\n\tmso-hansi-theme-font:minor-latin;\n\tmso-bidi-font-family:\"Times New Roman\";\n\tmso-bidi-theme-font:minor-bidi;\n\tmso-ansi-language:EN-US;\n\tmso-fareast-language:EN-US;}\n<\/style>\n\n\n\n\n\n\n<\/p>\r\n\n\n\n\n\n\r\n<div class=\"WordSection1W\">\n\n<p style=\"line-height:115%\"><span style=\"font-weight: bold;\"><a name=\"_\"><\/a><a name=\"Insuficiencia_suprarrenal:_clasificaci\u00f3n\"><\/a><span style=\"font-size: 24px;\">Insuficiencia<span style=\"letter-spacing:-1.05pt\"> <\/span>suprarrenal:<span style=\"letter-spacing:\n-1.05pt\"> <\/span>clasificaci\u00f3n, cl\u00ednica, diagn\u00f3stico y tratamiento<\/span><\/span><\/p>\n\n<p style=\"margin-top:12.0pt;margin-bottom:.0001pt;line-height:115%\"><span>La insuficiencia suprarrenal (IS) es un trastorno poco frecuente, con\nprevalencia estimada de 5\/10<span style=\"letter-spacing:-.2pt\"> <\/span>000<span style=\"letter-spacing:-.2pt\"> <\/span>en<span style=\"letter-spacing:-.2pt\"> <\/span>la<span style=\"letter-spacing:-.2pt\"> <\/span>poblaci\u00f3n<span style=\"letter-spacing:-.2pt\">\n<\/span>general.<span style=\"letter-spacing:-.2pt\"> <\/span>La<span style=\"letter-spacing:-.2pt\"> <\/span>forma<span style=\"letter-spacing:-.2pt\"> <\/span>m\u00e1s<span style=\"letter-spacing:-.2pt\"> <\/span>com\u00fan<span style=\"letter-spacing:-.2pt\"> <\/span>es<span style=\"letter-spacing:-.2pt\"> <\/span>la<span style=\"letter-spacing:-.2pt\"> <\/span>de<span style=\"letter-spacing:-.2pt\"> <\/span>origen<span style=\"letter-spacing:-.2pt\"> <\/span>hipotal\u00e1mico-hipofisario\n(3\/10 000), mientras que la primaria representa ~2\/10 000. En pa\u00edses\ndesarrollados, la causa m\u00e1s frecuente es la supresi\u00f3n iatrog\u00e9nica del eje\nhipotal\u00e1mico-hipofisario-adrenal (HPA) por glucocorticoides ex\u00f3genos (0.5\u20132% de\nla poblaci\u00f3n).<\/span><\/p>\n\n<p style=\"margin-top:5.35pt;margin-bottom:.0001pt\"><span>&nbsp;<\/span><\/p>\n\n<h1><a name=\"Clasificaci\u00f3n_etiol\u00f3gica_\"><\/a><span>Clasificaci\u00f3n<span style=\"letter-spacing:-.65pt\"> <\/span><span style=\"letter-spacing:-.1pt\">etiol\u00f3gica<\/span><\/span><\/h1>\n\n<p style=\"margin-top:14.9pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">IS<span style=\"letter-spacing:-.4pt\"> <\/span>primaria<span style=\"letter-spacing:-.3pt\">\n<\/span>(Enfermedad<span style=\"letter-spacing:-.3pt\"> <\/span>de<span style=\"letter-spacing:-.3pt\"> <\/span>Addison)<\/span><\/b><span>:<span style=\"letter-spacing:-.3pt\"> <\/span>destrucci\u00f3n<span style=\"letter-spacing:\n-.3pt\"> <\/span>o<span style=\"letter-spacing:-.3pt\"> <\/span>disfunci\u00f3n<span style=\"letter-spacing:-.3pt\"> <\/span>de<span style=\"letter-spacing:-.3pt\"> <\/span>la<span style=\"letter-spacing:-.3pt\"> <\/span>corteza<span style=\"letter-spacing:-.25pt\">\n<\/span><span style=\"letter-spacing:-.1pt\">adrenal.<\/span><\/span><\/p>\n\n<p style=\"margin-top:1.9pt;margin-right:6.1pt;margin-left:72.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">Causa<span style=\"letter-spacing:-.35pt\"> <\/span>m\u00e1s<span style=\"letter-spacing:-.35pt\"> <\/span>frecuente<span style=\"letter-spacing:-.35pt\"> <\/span><\/span><\/b><i><span style=\"font-family:&quot;Arial&quot;,sans-serif\">(preguntado<span style=\"letter-spacing:-.35pt\"> <\/span>previamente<span style=\"letter-spacing:-.35pt\"> <\/span>en<span style=\"letter-spacing:-.35pt\"> <\/span>CONAREM)<\/span><\/i><span>:<span style=\"letter-spacing:-.35pt\"> <\/span>suprarrenalitis\nautoinmunitaria (30\u201340% aislada; 60\u201370% dentro de s\u00edndrome poliglandular <span style=\"letter-spacing:-.1pt\">autoinmunitario).<\/span><\/span><\/p>\n\n<p style=\"margin-right:15.85pt;margin-left:72.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>S\u00edndromes<span style=\"letter-spacing:\n-.35pt\"> <\/span>poliglandulares<span style=\"letter-spacing:-.35pt\"> <\/span>autoinmunitarios<span style=\"letter-spacing:-.35pt\"> <\/span>(APS1<span style=\"letter-spacing:-.35pt\">\n<\/span>con<span style=\"letter-spacing:-.35pt\"> <\/span>mutaci\u00f3n<span style=\"letter-spacing:-.35pt\"> <\/span>AIRE;<span style=\"letter-spacing:-.35pt\">\n<\/span>APS2 asociado a HLA-DR3 y genes inmunorreguladores).<\/span><\/p>\n\n<p style=\"margin-right:26.2pt;margin-left:72.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;line-height:\n115%\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Adrenoleucodistrofia<span style=\"letter-spacing:-.3pt\"> <\/span>ligada<span style=\"letter-spacing:-.3pt\"> <\/span>a<span style=\"letter-spacing:-.3pt\"> <\/span>X:<span style=\"letter-spacing:-.3pt\"> <\/span>mutaciones<span style=\"letter-spacing:-.3pt\"> <\/span>ABCD1<span style=\"letter-spacing:-.3pt\"> <\/span>con<span style=\"letter-spacing:-.3pt\"> <\/span>fenotipos<span style=\"letter-spacing:-.3pt\">\n<\/span>variables (ALD cerebral, adrenomieloneuropat\u00eda, forma aislada de IS).<\/span><\/p>\n\n<p style=\"margin-right:45.95pt;margin-left:72.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Hiperplasia<span style=\"letter-spacing:\n-.5pt\"> <\/span>suprarrenal<span style=\"letter-spacing:-.5pt\"> <\/span>cong\u00e9nita:<span style=\"letter-spacing:-.5pt\"> <\/span>mutaciones<span style=\"letter-spacing:\n-.5pt\"> <\/span>en<span style=\"letter-spacing:-.5pt\"> <\/span>CYP21A2,<span style=\"letter-spacing:-.5pt\"> <\/span>CYP11B1, CYP17A1 y otras.<\/span><\/p>\n\n<p style=\"margin-right:1.85pt;margin-left:72.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;line-height:\n115%\"><span><span>\u25cb<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Otras causas: infecciones\n(tuberculosis, VIH, CMV, histoplasmosis, coccidioidomicosis) <\/span><i><span style=\"font-family:&quot;Arial&quot;,sans-serif\">(<b>preguntado\npreviamente en CONAREM: TAC con gl\u00e1ndulas aumentadas y calcificaciones sugiere\nTB)<\/b><\/span><\/i><span>; infiltraci\u00f3n (linfoma, met\u00e1stasis,<span style=\"letter-spacing:-.4pt\"> <\/span>sarcoidosis,<span style=\"letter-spacing:\n-.4pt\"> <\/span>amiloidosis,<span style=\"letter-spacing:-.4pt\"> <\/span>hemocromatosis);<span style=\"letter-spacing:-.4pt\"> <\/span>hemorragia<span style=\"letter-spacing:\n-.4pt\"> <\/span>(s\u00edndrome<span style=\"letter-spacing:-.4pt\"> <\/span>de\nWaterhouse-Friderichsen, s\u00edndrome antifosfol\u00edpido); f\u00e1rmacos (ketoconazol,\netomidato, mitotano).<\/span><\/p>\n\n<p><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">IS<span style=\"letter-spacing:-.5pt\"> <\/span>secundaria<span style=\"letter-spacing:\n-.35pt\"> <\/span><\/span><\/b><i><span hipotal=\"\" mica=\"\" craneofaringiomas=\"\" meningiomas=\"\" met=\"\" stasis=\"\" radiaci=\"\" sheehan=\"\" hipofisaria=\"\" hipofisitis=\"\" autoinmune=\"\" granulomatosa=\"\" mutaciones=\"\" genes=\"\" desarrollo=\"\" hipofisario=\"\" prop-1=\"\" tbx19=\"\" etc=\"\" caracter=\"\" stica=\"\" clave=\"\" con=\"\" funci=\"\" mineralocorticoide=\"\" preservada=\"\" eje=\"\" renina-angiotensina=\"\" intacto=\"\" br=\"\" clear=\"all\n\" div=\"\" class=\"WordSection2W\" nicas=\"\" ntomas=\"\" inespec=\"\" ficos=\"\" fatiga=\"\" anorexia=\"\" rdida=\"\" peso=\"\" debilidad=\"\" mialgias=\"\" depresi=\"\" hiperpigmentaci=\"\" mucosa=\"\" zonas=\"\" fricci=\"\" exposici=\"\" solar=\"\" exceso=\"\" ptidos=\"\" derivados=\"\" pomc=\"\" 80=\"\" 40=\"\" m=\"\" ni=\"\" os=\"\" apetencia=\"\" la=\"\" sal=\"\" deshidrataci=\"\" aumento=\"\" creatinina=\"\" h2=\"\" palidez=\"\" cut=\"\" nea=\"\" marcada=\"\" hiponatremia=\"\" frecuente=\"\" pero=\"\" sin=\"\" hiperpotasemia=\"\" manifestaciones=\"\" otros=\"\" ficits=\"\" hipofisarios=\"\" hipotiroidismo=\"\" hipogonadismo=\"\" d=\"\" ficit=\"\" gh=\"\" hiperprolactinemia=\"\" insuficiencia=\"\" aguda=\"\" previamente=\"\" conarem=\"\" desencadenantes:=\"\" infecciones=\"\" cirug=\"\" as=\"\" traumatismos=\"\" suspensi=\"\" brusca=\"\" glucocorticoides=\"\" ex=\"\" genos=\"\" s=\"\" ndrome=\"\" supresi=\"\" suprarrenal=\"\" covid=\"\" tambi=\"\" preguntado=\"\" i=\"\" cuadro=\"\" cl=\"\" nico:=\"\" hipotensi=\"\" ortost=\"\" tica=\"\" progresa=\"\" choque=\"\" hipovol=\"\" mico=\"\" dolor=\"\" abdominal=\"\" usea=\"\" v=\"\" mitos=\"\" fiebre=\"\" hipoglucemia=\"\" alteraciones=\"\" neurol=\"\" gicas=\"\" que=\"\" pueden=\"\" evolucionar=\"\" estupor=\"\" coma=\"\" mortalidad:=\"\" 8=\"\" 3=\"\" crisis=\"\" y=\"\" 0=\"\" 5=\"\" muertes=\"\" por=\"\" 100=\"\" pacientes-=\"\" name=\"Diagn\u00f3stico_\" diagn=\"\" stico=\"\" h1=\"\" prueba=\"\" corta=\"\" cosintropina=\"\" :=\"\" cortisol=\"\" lt=\"\" 450=\"\" 500=\"\" nmol=\"\" l=\"\" 16=\"\" 18=\"\" g=\"\" dl=\"\" los=\"\" 30=\"\" 60=\"\" min=\"\" post=\"\" acth=\"\" confirma=\"\" medici=\"\" acth:=\"\" is=\"\" baja=\"\" o=\"\" renina=\"\" plasm=\"\" tica:=\"\" elevada=\"\" primaria=\"\" normal=\"\" secundaria=\"\" autoanticuerpos=\"\" contra=\"\" esteroides:=\"\" confirman=\"\" suprarrenalitis=\"\" autoinmunitaria=\"\" imagen:=\"\" ct=\"\" suprarrenal:=\"\" masas=\"\" hemorragia=\"\" calcificaciones=\"\" sugiere=\"\" tb=\"\" rm=\"\" hipofisaria:=\"\" adenomas=\"\" apoplej=\"\" a=\"\" infiltraci=\"\" n=\"\" estudios=\"\" adicionales:=\"\" cidos=\"\" grasos=\"\" de=\"\" cadena=\"\" muy=\"\" larga=\"\" en=\"\" varones=\"\" descartar=\"\" x-=\"\" ald=\"\" p=\"\" nbsp=\"\" importante:=\"\" style=\"letter-spacing:\n-.25pt\" b=\"\" span=\"\" mt=\"\">el<span style=\"letter-spacing:-.25pt\"> <\/span>tratamiento<span style=\"letter-spacing:\n-.25pt\"> <\/span>no<span style=\"letter-spacing:-.25pt\"> <\/span>debe<span style=\"letter-spacing:-.25pt\"> <\/span>retrasarse<span style=\"letter-spacing:\n-.25pt\"> <\/span>esperando<span style=\"letter-spacing:-.25pt\"> <\/span>confirmaci\u00f3n<span style=\"letter-spacing:-.25pt\"> <\/span><\/span><span>en<span style=\"letter-spacing:-.25pt\"> <\/span>sospecha de crisis.<\/span><\/i><\/p>\n\n<\/div>\r\n\n\n\n\n\n\n\n\n\r\n<span style=\"font-size:11.0pt;line-height:115%;font-family:&quot;Arial MT&quot;,sans-serif\"><br clear=\"all\n\" style=\"page-break-before:always\" \/>\n<\/span>\r\n\n\n\n\n\n\n\n\n\r\n<h1 style=\"margin-top:3.0pt\"><a name=\"Tratamiento_\"><\/a><span style=\"letter-spacing:-.1pt\">Tratamiento<\/span><\/h1>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-top:16.9pt\"><a name=\"Insuficiencia_aguda_(preguntado_previame\"><\/a><b><span style=\"font-size:13.0pt;\nfont-family:&quot;Arial&quot;,sans-serif\">Insuficiencia<span style=\"letter-spacing:-.55pt\"> <\/span>aguda<span style=\"letter-spacing:-.4pt\"> <\/span><i>(preguntado<span style=\"letter-spacing:-.45pt\"> <\/span>previamente<span style=\"letter-spacing:\n-.4pt\"> <\/span>en<span style=\"letter-spacing:-.4pt\"> <\/span><span style=\"letter-spacing:-.1pt\">CONAREM)<\/span><\/i><\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-top:14.25pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Rehidrataci\u00f3n<span style=\"letter-spacing:-.3pt\"> <\/span>inmediata<span style=\"letter-spacing:-.25pt\">\n<\/span>con<span style=\"letter-spacing:-.25pt\"> <\/span>SSN<span style=\"letter-spacing:-.25pt\"> <\/span>1<span style=\"letter-spacing:-.25pt\"> <\/span>L\/h<span style=\"letter-spacing:-.25pt\"> <\/span>bajo<span style=\"letter-spacing:-.25pt\"> <\/span><span style=\"letter-spacing:-.1pt\">monitorizaci\u00f3n.<\/span><\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Hidrocortisona<span style=\"letter-spacing:-.3pt\"> <\/span>100<span style=\"letter-spacing:-.2pt\"> <\/span>mg<span style=\"letter-spacing:-.2pt\"> <\/span>IV<span style=\"letter-spacing:-.2pt\"> <\/span>bolo<span style=\"letter-spacing:-.2pt\"> <\/span>\u2192<span style=\"letter-spacing:-.15pt\"> <\/span>200<span style=\"letter-spacing:-.2pt\"> <\/span>mg\/24<span style=\"letter-spacing:-.2pt\"> <\/span>h<span style=\"letter-spacing:-.2pt\"> <\/span>en<span style=\"letter-spacing:-.2pt\"> <\/span>infusi\u00f3n<span style=\"letter-spacing:-.2pt\"> <\/span>o<span style=\"letter-spacing:-.15pt\"> <\/span><span style=\"letter-spacing:-.1pt\">bolos.<\/span><\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-top:1.9pt;margin-right:8.15pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Mineralocorticoides:<span style=\"letter-spacing:-.25pt\"> <\/span>iniciar<span style=\"letter-spacing:-.25pt\">\n<\/span>cuando<span style=\"letter-spacing:-.25pt\"> <\/span>hidrocortisona<span style=\"letter-spacing:-.25pt\"> <\/span>&lt;50<span style=\"letter-spacing:-.25pt\">\n<\/span>mg\/d\u00eda<span style=\"letter-spacing:-.25pt\"> <\/span>(dosis<span style=\"letter-spacing:-.25pt\"> <\/span>altas<span style=\"letter-spacing:-.25pt\">\n<\/span>tienen<span style=\"letter-spacing:-.25pt\"> <\/span>efecto <span style=\"letter-spacing:-.1pt\">suficiente).<\/span><\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-top:1.35pt;margin-bottom:.0001pt\"><span>&nbsp;<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p class=\"MsoNormalM\"><a name=\"Insuficiencia_cr\u00f3nica_\"><\/a><b><span style=\"font-size:13.0pt;\nfont-family:&quot;Arial&quot;,sans-serif\">Insuficiencia<span style=\"letter-spacing:-.65pt\"> <\/span><span style=\"letter-spacing:-.1pt\">cr\u00f3nica<\/span><\/span><\/b><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-top:14.25pt;margin-right:42.05pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">Glucocorticoides<\/span><\/b><span>:<span style=\"letter-spacing:-.25pt\"> <\/span>hidrocortisona<span style=\"letter-spacing:-.25pt\"> <\/span>15\u201325<span style=\"letter-spacing:-.25pt\">\n<\/span>mg<span style=\"letter-spacing:-.25pt\"> <\/span>VO<span style=\"letter-spacing:\n-.25pt\"> <\/span>en<span style=\"letter-spacing:-.25pt\"> <\/span>2\u20133<span style=\"letter-spacing:-.25pt\"> <\/span>dosis;<span style=\"letter-spacing:-.25pt\">\n<\/span>duplicar<span style=\"letter-spacing:-.25pt\"> <\/span>dosis<span style=\"letter-spacing:-.25pt\"> <\/span>en fiebre\/infecci\u00f3n; aumentar 50% en\nembarazo (\u00faltimo trimestre).<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-right:34.1pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;line-height:\n115%\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Evitar<span style=\"letter-spacing:\n-.25pt\"> <\/span>glucocorticoides<span style=\"letter-spacing:-.25pt\"> <\/span>de<span style=\"letter-spacing:-.25pt\"> <\/span>acci\u00f3n<span style=\"letter-spacing:-.25pt\">\n<\/span>larga<span style=\"letter-spacing:-.25pt\"> <\/span>(prednisona,<span style=\"letter-spacing:-.25pt\"> <\/span>dexametasona)<span style=\"letter-spacing:\n-.25pt\"> <\/span>por<span style=\"letter-spacing:-.25pt\"> <\/span>riesgo<span style=\"letter-spacing:-.25pt\"> <\/span>de <span style=\"letter-spacing:-.1pt\">sobreexposici\u00f3n.<\/span><\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-right:34.95pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><span>Ajuste<span style=\"letter-spacing:\n-.25pt\"> <\/span>guiado<span style=\"letter-spacing:-.25pt\"> <\/span>cl\u00ednicamente<span style=\"letter-spacing:-.25pt\"> <\/span>(peso,<span style=\"letter-spacing:-.25pt\">\n<\/span>TA,<span style=\"letter-spacing:-.25pt\"> <\/span>s\u00edntomas);<span style=\"letter-spacing:-.25pt\"> <\/span>ACTH<span style=\"letter-spacing:-.25pt\"> <\/span>y<span style=\"letter-spacing:-.25pt\"> <\/span>cortisol<span style=\"letter-spacing:-.25pt\">\n<\/span>en<span style=\"letter-spacing:-.25pt\"> <\/span>orina<span style=\"letter-spacing:-.25pt\"> <\/span>no<span style=\"letter-spacing:-.25pt\"> <\/span>son\nconfiables para ajuste.<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-right:13.95pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif;\nletter-spacing:-.1pt\">Mineralocorticoides<\/span><\/b><span style=\"letter-spacing:-.1pt\">: fludrocortisona 100\u2013150 \u03bcg\/d\u00eda; ajustar seg\u00fan\nPA, electrolitos y <\/span><span>renina. Requiere aumentos en clima\ncaluroso o embarazo.<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-right:45.75pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">Andr\u00f3genos<\/span><\/b><span>:<span style=\"letter-spacing:-.2pt\"> <\/span>DHEA<span style=\"letter-spacing:\n-.2pt\"> <\/span>25\u201350<span style=\"letter-spacing:-.2pt\"> <\/span>mg\/d\u00eda<span style=\"letter-spacing:-.2pt\"> <\/span>en<span style=\"letter-spacing:-.2pt\"> <\/span>mujeres<span style=\"letter-spacing:-.2pt\"> <\/span>con<span style=\"letter-spacing:-.2pt\"> <\/span>baja<span style=\"letter-spacing:-.2pt\"> <\/span>libido,<span style=\"letter-spacing:-.2pt\">\n<\/span>p\u00e9rdida<span style=\"letter-spacing:-.2pt\"> <\/span>de<span style=\"letter-spacing:-.2pt\"> <\/span>vello axilar\/p\u00fabico o fatiga persistente.<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-right:12.7pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;line-height:\n115%\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">Educaci\u00f3n\ndel paciente<\/span><\/b><span>: todos deben portar brazalete\/tarjeta de\nesteroides, kit de hidrocortisona<span style=\"letter-spacing:-.2pt\"> <\/span>para<span style=\"letter-spacing:-.2pt\"> <\/span>emergencias<span style=\"letter-spacing:\n-.2pt\"> <\/span>y<span style=\"letter-spacing:-.2pt\"> <\/span>conocer<span style=\"letter-spacing:-.2pt\"> <\/span>ajustes<span style=\"letter-spacing:-.2pt\">\n<\/span>de<span style=\"letter-spacing:-.2pt\"> <\/span>dosis<span style=\"letter-spacing:-.2pt\"> <\/span>en<span style=\"letter-spacing:-.2pt\"> <\/span>infecciones,<span style=\"letter-spacing:-.2pt\"> <\/span>v\u00f3mitos<span style=\"letter-spacing:-.2pt\">\n<\/span>o <span style=\"letter-spacing:-.1pt\">cirug\u00edas.<\/span><\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-top:5.35pt;margin-bottom:.0001pt\"><span>&nbsp;<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<h1><a name=\"Informaci\u00f3n_clave_para_examen_\"><\/a><span>Informaci\u00f3n<span style=\"letter-spacing:-.45pt\"> <\/span>clave<span style=\"letter-spacing:-.35pt\">\n<\/span>para<span style=\"letter-spacing:-.3pt\"> <\/span><span style=\"letter-spacing:\n-.1pt\">examen<\/span><\/span><\/h1>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-top:14.95pt\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">Causa<span style=\"letter-spacing:-.35pt\"> <\/span>m\u00e1s<span style=\"letter-spacing:-.3pt\"> <\/span>frecuente<span style=\"letter-spacing:-.35pt\"> <\/span>de<span style=\"letter-spacing:-.3pt\"> <\/span>IS<span style=\"letter-spacing:-.35pt\"> <\/span>primaria<\/span><\/b><span>:<span style=\"letter-spacing:-.3pt\"> <\/span>suprarrenalitis<span style=\"letter-spacing:\n-.3pt\"> <\/span><span style=\"letter-spacing:-.1pt\">autoinmunitaria.<\/span><\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">Tuberculosis<\/span><\/b><span>:<span style=\"letter-spacing:-.55pt\"> <\/span>sospechar<span style=\"letter-spacing:-.55pt\"> <\/span>si<span style=\"letter-spacing:-.55pt\"> <\/span>TAC<span style=\"letter-spacing:-.5pt\"> <\/span>muestra<span style=\"letter-spacing:-.55pt\">\n<\/span>gl\u00e1ndulas<span style=\"letter-spacing:-.55pt\"> <\/span>agrandadas<span style=\"letter-spacing:-.55pt\"> <\/span>y<span style=\"letter-spacing:-.5pt\"> <\/span><span style=\"letter-spacing:-.1pt\">calcificadas.<\/span><\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-top:1.9pt;margin-right:38.35pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">Primaria<span style=\"letter-spacing:-.3pt\"> <\/span>vs<span style=\"letter-spacing:-.3pt\"> <\/span>secundaria<\/span><\/b><span>:<span style=\"letter-spacing:-.3pt\"> <\/span>hiperpigmentaci\u00f3n<span style=\"letter-spacing:-.3pt\"> <\/span>e<span style=\"letter-spacing:-.3pt\"> <\/span>hiperpotasemia<span style=\"letter-spacing:-.3pt\"> <\/span>presentes<span style=\"letter-spacing:-.3pt\">\n<\/span>solo<span style=\"letter-spacing:-.3pt\"> <\/span>en primaria; secundaria\ncon palidez e hiponatremia sin hiperK.<\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p style=\"margin-right:57.65pt;margin-left:36.0pt;margin-bottom:.0001pt;text-indent:-18.0pt;\nline-height:115%\"><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">Crisis<span style=\"letter-spacing:-.3pt\"> <\/span>suprarrenal<\/span><\/b><span>:<span style=\"letter-spacing:-.3pt\"> <\/span>hidrocortisona<span style=\"letter-spacing:\n-.3pt\"> <\/span>EV<span style=\"letter-spacing:-.3pt\"> <\/span>inmediata<span style=\"letter-spacing:-.3pt\"> <\/span>+<span style=\"letter-spacing:-.3pt\"> <\/span>rehidrataci\u00f3n,<span style=\"letter-spacing:-.3pt\"> <\/span>sin<span style=\"letter-spacing:-.3pt\"> <\/span>esperar\n<span style=\"letter-spacing:-.1pt\">confirmaci\u00f3n.<\/span><\/span><\/p>\r\n\n\n\n\n\n\n\n\n\r\n<p><span><span>\u25cf<span style=\"font:7.0pt &quot;Times New Roman&quot;\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;\n<\/span><\/span><\/span><b><span style=\"font-family:&quot;Arial&quot;,sans-serif\">Supresi\u00f3n<span style=\"letter-spacing:-.4pt\"> <\/span>yatr\u00f3gena<\/span><\/b><span>:<span style=\"letter-spacing:-.3pt\"> <\/span>causa<span style=\"letter-spacing:-.3pt\"> <\/span>m\u00e1s<span style=\"letter-spacing:-.25pt\"> <\/span>com\u00fan<span style=\"letter-spacing:-.3pt\"> <\/span>en<span style=\"letter-spacing:-.3pt\"> <\/span>pa\u00edses<span style=\"letter-spacing:-.25pt\">\n<\/span><span style=\"letter-spacing:-.1pt\">desarrollados.<\/span><\/span><\/p>\r\n\n\n\n\n\n\n\n\n\n\r\n<br \/>",
        "footer": "P\u00e1gina 1"
    }
]