New aspects of glucocorticoid substitution in adrenal insufficiency

This article was originally published here

Internist (Berl). 2021 Dec 3. doi: 10.1007/s00108-021-01209-4. Online ahead of print.

ABSTRACT

BACKGROUND: Appropriate glucocorticoid dose adjustment in specific situations significantly impacts quality of life and performance of patients with adrenal insufficiency. It is also pivotal for the prevention of adrenal crisis.

OBJECTIVES: Improving medical care for patients with adrenal insufficiency.

MATERIALS AND METHODS: Selective literature research focussing on the most recent studies.

RESULTS: Optimal glucocorticoid substitution aims at closely mimicking physiological fluctuations of cortisol levels. In recent years glucocorticoid preparations with modified pharmacokinetics have expanded the therapeutic arsenal. Adrenal crises occur with an incidence of 4.8-9.3 crises per 100 patient years. With a mortality of 0.5 per 100 patient years adrenal crisis is a life-threatening event. Therefore, it is of the utmost importance to adjust glucocorticoid dose in situations with increased cortisol demand in order to prevent as well as appropriately treat adrenal crisis.

CONCLUSIONS: To prevent life-threatening adrenal crisis, patients, their families and medical staff require training.

PMID:34860258 | DOI:10.1007/s00108-021-01209-4