{"id":55,"date":"2020-04-20T14:17:17","date_gmt":"2020-04-20T14:17:17","guid":{"rendered":"https:\/\/live-rawf.pantheonsite.io\/2020\/04\/20\/2020-4-20-managing-hypopituitarism-patients-during-covid-19\/"},"modified":"2023-08-01T19:28:40","modified_gmt":"2023-08-01T19:28:40","slug":"2020-4-20-prise-en-charge-des-patients-atteints-dhypopituitarisme-au-cours-de-la-covid-19","status":"publish","type":"post","link":"https:\/\/www.rawoodfoundation.org\/fr\/2020\/04\/20\/2020-4-20-managing-hypopituitarism-patients-during-covid-19\/","title":{"rendered":"Prise en charge des patients atteints d'hypopituitarisme pendant le COVID-19"},"content":{"rendered":"<\/p>\n<\/p>\n<\/p>\n
<\/p>\n

\n

La plupart des patients atteints de tumeurs c\u00e9r\u00e9brales hypothalamo-hypophysaires souffrent d'insuffisance surr\u00e9nale secondaire (ISC), c'est-\u00e0-dire de l'incapacit\u00e9 du cerveau \u00e0 signaler la production de cortisol en cas de d\u00e9tresse de l'organisme, et de diab\u00e8te insipide (DI), qui r\u00e9sulte de la perturbation de la production de l'hormone antidiur\u00e9tique, ce qui entra\u00eene des probl\u00e8mes d'\u00e9quilibre des fluides corporels et de taux de sodium dans le sang. Avec l'\u00e9pid\u00e9mie de coronavirus, de nombreuses questions ont \u00e9t\u00e9 soulev\u00e9es sur le fait que les patients atteints d'ISC sont immunod\u00e9prim\u00e9s ou \"\u00e0 haut risque\". <\/p>\n

Quelques articles ont \u00e9t\u00e9 publi\u00e9s r\u00e9cemment sur ce sujet. Le Journal of Clinical Endocrinology & Metabolism (JCEM) a publi\u00e9 un article en ligne.<\/a> Il y a quelques semaines, nous avons publi\u00e9 un article dans le num\u00e9ro de mai 2020 qui met en \u00e9vidence quelques lignes directrices \u00e0 prendre en compte pour les patients souffrant d'ISC et d'AI. Voici quelques points cl\u00e9s : <\/p>\n

Dose d'entretien <\/h2>\n

Les patients doivent continuer \u00e0 prendre leur dose d'entretien quotidienne de st\u00e9ro\u00efdes. M\u00eame si l'utilisation de st\u00e9ro\u00efdes peut placer les patients dans la cat\u00e9gorie \u00e0 haut risque COVID-19, le fait de ne pas prendre la dose d'entretien quotidienne expose le patient \u00e0 un risque plus \u00e9lev\u00e9 de crise surr\u00e9nalienne. <\/p>\n

Dose de stress <\/h2>\n

Les patients devraient revoir les \"r\u00e8gles de l'arr\u00eat de travail\" avec leur m\u00e9decin. En cas de sympt\u00f4mes li\u00e9s \u00e0 COVID-19 - \u00e0 savoir une toux s\u00e8che et de la fi\u00e8vre - il peut \u00eatre n\u00e9cessaire d'administrer une dose de stress. Il ne faut administrer une dose de stress qu'en cas de sympt\u00f4mes et non pour les pr\u00e9venir. Si l'\u00e9tat du patient s'aggrave et qu'il souffre de vomissements ou de diarrh\u00e9e, il convient de lui prodiguer des soins m\u00e9dicaux d'urgence. <\/p>\n

St\u00e9ro\u00efdes et COVID-19 <\/h2>\n

L'Organisation mondiale de la sant\u00e9 (OMS) a indiqu\u00e9 que les st\u00e9ro\u00efdes ne constituent pas un traitement pour le COVID-19. Selon le JCEM, en cas de maladie et d'hospitalisation, les m\u00e9decins traitants doivent administrer de l'hydrocortisone par voie intraveineuse. <\/p>\n

Maladie et diab\u00e8te insipide <\/h2>\n

La maladie et les doses de stress des st\u00e9ro\u00efdes peuvent \u00e9galement avoir un impact sur la gestion des fluides. Selon le JCEM, il est important de surveiller attentivement les entr\u00e9es et les sorties tout en tenant compte des pertes insensibles dues \u00e0 la fi\u00e8vre afin d'\u00e9viter les d\u00e9s\u00e9quilibres en sodium, surtout si le patient pr\u00e9sente des troubles de la conscience en raison d'une maladie. <\/p>\n

Se pr\u00e9parer \u00e0 une hospitalisation <\/h2>\n

\u00c9tant donn\u00e9 que les patients atteints d'ISC ou d'AI peuvent avoir besoin d'\u00eatre hospitalis\u00e9s de temps \u00e0 autre en dehors d'une crise sanitaire mondiale, il est conseill\u00e9 de v\u00e9rifier r\u00e9guli\u00e8rement aupr\u00e8s de l'h\u00f4pital qui vous traite les directives en vigueur concernant les visiteurs et tout autre changement de politique qui pourrait vous concerner. Ayez une lettre d'urgence \u00e0 jour de votre endocrinologue \u00e0 fournir \u00e0 votre arriv\u00e9e \u00e0 l'h\u00f4pital. Si vous n'avez pas de lettre, une documentation concise sur vos ant\u00e9c\u00e9dents m\u00e9dicaux est \u00e9galement utile. <\/p>\n

Conclusion<\/h2>\n

J'esp\u00e8re que cela vous aidera \u00e0 mieux comprendre les informations disponibles sur ces conditions li\u00e9es \u00e0 COVID-19. Pour rester en bonne sant\u00e9 et assurer sa propre s\u00e9curit\u00e9 et celle des autres, il est pr\u00e9f\u00e9rable de continuer \u00e0 suivre les recommandations des CDC, \u00e0 savoir prendre des distances sociales, rester \u00e0 la maison lorsque c'est possible et porter un masque pour \u00e9viter la propagation de la maladie. <\/p>\n

Sources d'information<\/h2>\n

Notre r\u00e9ponse au COVID-19 en tant qu'endocrinologues et diab\u00e9tologues<\/a>
<\/em>Ursula B Kaiser, Raghavendra G Mirmira, Paul M Stewart
The Journal of Clinical Endocrinology & Metabolism (Journal de l'endocrinologie clinique et du m\u00e9tabolisme)<\/p>\n

Si vous pr\u00e9sentez un risque \u00e9lev\u00e9 : Comment r\u00e9duire le risque d'infection et que faire si vous tombez malade ?<\/a>
Harvard Health Publishing<\/p>\n

Prise en charge des patients souffrant d'un dysfonctionnement endocrinien pendant la conf\u00e9rence COVID-19<\/a>
Nouvelles m\u00e9dicales aujourd'hui<\/p>\n

Ce qu'il faut savoir si l'on souffre d'une maladie endocrinienne pendant la pand\u00e9mie de coronavirus<\/a>
U.S. News & World Report<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

La plupart des patients atteints de tumeurs c\u00e9r\u00e9brales hypothalamo-hypophysaires souffrent d'insuffisance surr\u00e9nale secondaire (ISC), c'est-\u00e0-dire de l'incapacit\u00e9 du cerveau \u00e0 signaler la production de cortisol en cas de d\u00e9tresse de l'organisme, et de diab\u00e8te insipide (DI), qui r\u00e9sulte de la perturbation de la production de l'hormone antidiur\u00e9tique, ce qui entra\u00eene des probl\u00e8mes d'\u00e9quilibre des fluides corporels et de taux de sodium dans le sang. Avec l'\u00e9pid\u00e9mie de coronavirus, de nombreuses questions ont \u00e9t\u00e9 soulev\u00e9es sur le fait que les patients atteints d'ISC sont immunod\u00e9prim\u00e9s ou \"\u00e0 haut risque\".<\/p>","protected":false},"author":6,"featured_media":56,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[42,1],"tags":[],"class_list":["post-55","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-medical","category-uncategorized","generate-columns","tablet-grid-50","mobile-grid-100","grid-parent","grid-33","no-featured-image-padding"],"acf":[],"yoast_head":"\nManaging Hypopituitarism Patients During COVID-19 - Raymond A. 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