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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">mvjr</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинский вестник Юга России</journal-title><trans-title-group xml:lang="en"><trans-title>Medical Herald of the South of Russia</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2219-8075</issn><issn pub-type="epub">2618-7876</issn><publisher><publisher-name>The Rostov State Medical University</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21886/2219-8075-2024-15-3-48-54</article-id><article-id custom-type="elpub" pub-id-type="custom">mvjr-1854</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ЭНДОКРИНОЛОГИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ENDOCRYNOLOGY</subject></subj-group></article-categories><title-group><article-title>Глюкокортикоид-индуцированная недостаточность коры надпочечников</article-title><trans-title-group xml:lang="en"><trans-title>Glucocorticoid-induced adrenal insufficiency</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9574-105X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ворохобина</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Vorokhobina</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ворохобина Наталья Владимировна, д.м.н., профессор</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>Natalya V. Vorokhobina, Dr. Sci. (Med.), Prof.</p><p>Saint-Petersburg</p></bio><email xlink:type="simple">natvorokh@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8734-2449</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Фогт</surname><given-names>С. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Fogt</surname><given-names>S. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Фогт Сергей Николаевич, к.м.н.</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>Sergei N. Fogt, Cand. Sci. (Med.)</p><p>Saint-Petersburg</p></bio><email xlink:type="simple">s_fogt@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0797-2051</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мазуров</surname><given-names>В. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Mazurov</surname><given-names>V. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мазуров Вадим Иванович, д.м.н., профессор, академик РАН</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>Vadim I. Mazurov, Dr. Sci. (Med.)</p><p>Saint-Petersburg</p></bio><email xlink:type="simple">maz.nwgmu@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7981-6349</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Беляева</surname><given-names>И. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Beliaeva</surname><given-names>I. B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Беляева Ирина Борисовна, д.м.н., профессор</p><p>Клиническая ревматологическая больница № 25</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>Irina B. Beliaeva, Dr. Sci. (Med.), Prof.</p><p>St. Petersburg</p></bio><email xlink:type="simple">belib@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3599-3199</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Галахова</surname><given-names>Р. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Galakhova</surname><given-names>R. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Галахова Равиля Камильевна, к.м.н.</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>Ravilya K. Galakhova, Cand. Sci. (Med.)</p><p>Saint-Petersburg</p></bio><email xlink:type="simple">rgalakhova@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1977-8299</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Баландина</surname><given-names>К. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Balandina</surname><given-names>K. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Баландина Ксения Александровна, к.м.н.</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>Kseniya A. Balandina, Cand. Sci. (Med.)</p><p>Saint-Petersburg</p></bio><email xlink:type="simple">ksenya_sautina@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4990-5946</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кузнецова</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kuznetsova</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кузнецова Алла Васильевна, к.м.н.</p><p>Санкт-Петербург</p></bio><bio xml:lang="en"><p>Alla V. Kuznetsova, Cand. Sci. (Med.)</p><p>Saint-Petersburg</p></bio><email xlink:type="simple">all-kuznetsova@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Северо-Западный государственный медицинский университет им. И. И. Мечникова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>North-Western State Medical University n. a. I.I. Metchnikov</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Клиническая ревматологическая больница № 25</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Clinical Rheumatology Hospital No. 25</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Северо-Западный государственный медицинский университет им. И.И.  Мечникова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>North-Western State Medical University n. a. I.I. Metchnikov</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>10</day><month>07</month><year>2024</year></pub-date><volume>15</volume><issue>3</issue><fpage>48</fpage><lpage>54</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Ворохобина Н.В., Фогт С.Н., Мазуров В.И., Беляева И.Б., Галахова Р.К., Баландина К.А., Кузнецова А.В., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Ворохобина Н.В., Фогт С.Н., Мазуров В.И., Беляева И.Б., Галахова Р.К., Баландина К.А., Кузнецова А.В.</copyright-holder><copyright-holder xml:lang="en">Vorokhobina N.V., Fogt S.N., Mazurov V.I., Beliaeva I.B., Galakhova R.K., Balandina K.A., Kuznetsova A.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.medicalherald.ru/jour/article/view/1854">https://www.medicalherald.ru/jour/article/view/1854</self-uri><abstract><p>Системные глюкокортикоиды активно используются не только при эндокринных заболеваниях, но и в терапевтической практике. По данным различных авторов 1–3% человек в общей популяции применяет системные глюкокортикоиды, до 1,8% — длительно. При этом 50% пациентов, принимающих эти препараты перорально, имеет после их отмены глюкокортикоид-индуцированную недостаточность коры надпочечников (ГИНКН). Несмотря на подобный масштаб проблемы и длительность изучения вопроса, стандартных алгоритмов снижения дозы или отмены глюкокортикоидов в настоящее время нет. Доказательная база по этому вопросу сформирована на относительно немногочисленных клинических исследованиях, крайне гетерогенных в отношении исследуемых популяций, дизайнов, режимов использования глюкокортикоидов, диагностических подходов к недостаточности коры надпочечников. Таким образом, весомость доказательств по этому вопросу остаётся низкой, что приводит к тому, что каждое лечебное учреждение имеет свои подходы к снижению дозы и отмене глюкокортикоидов или не имеет их вовсе. В настоящей статье обобщены современные сведения о ГИНКН, позволяющие стандартизировать подходы к снижению дозы или отмене глюкокортикоидов. Совершенствование тактики ведения пациентов, длительно получавших препараты глюкокортикоидов, приведёт к уменьшению риска осложнений ГИНКН, в том числе жизнеугрожающих, а также к существенному улучшению качества жизни пациентов.</p></abstract><trans-abstract xml:lang="en"><p>Currently, systemic glucocorticoids are taken by about 1–3% of the general population, up to 1.8% long-term. Moreover, about 50% of patients taking these drugs orally develop glucocorticoid-induced adrenal insufficiency (GIAI) after their withdrawal. Despite this scale of the problem and the length of time the issue has been studied, there are currently no standard algorithms for reducing the dose or discontinuing glucocorticoids. The evidence base on this issue has been performed on relatively few clinical studies, which are extremely heterogeneous with respect to the populations studied, designs, regimens of glucocorticoid use, and diagnostic approaches to adrenal insufficiency. Thus, the weight of evidence on this issue remains inadequate, resulting in each institution having its own approach to dose reduction and discontinuation of glucocorticoids, or no approach at all. This article summarizes current information about GIAI, allowing for improved approaches to dose reduction or discontinuation of glucocorticoids. Improving the management tactics of patients who have been receiving glucocorticoids for a long time will lead to a reduction in the risk of complications of GIAI, including life-threatening ones, as well as to a significant improvement in the quality of life of patients.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>недостаточность коры надпочечников</kwd><kwd>глюкокортикоиды</kwd><kwd>симптомы при отмене препарата</kwd></kwd-group><kwd-group xml:lang="en"><kwd>adrenal insufficiency</kwd><kwd>glucocorticoids</kwd><kwd>drug withdrawal symptoms</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Benedek TG. History of the development of corticosteroid therapy. Clin Exp Rheumatol. 2011;29(5 Suppl 68):S-5-12. PMID: 22018177.</mixed-citation><mixed-citation xml:lang="en">Benedek TG. History of the development of corticosteroid therapy. 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