Improving glucocorticoid replacement profiles in adrenal insufficiency.
adrenal insufficiency
cortisol
glucocorticoids
hydrocortisone
hypocortisolism
prednisolone
Journal
Clinical endocrinology
ISSN: 1365-2265
Titre abrégé: Clin Endocrinol (Oxf)
Pays: England
ID NLM: 0346653
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
26
01
2019
revised:
19
04
2019
accepted:
23
04
2019
pubmed:
25
4
2019
medline:
10
9
2020
entrez:
25
4
2019
Statut:
ppublish
Résumé
There is an increased mortality associated with adrenal insufficiency despite glucocorticoid replacement therapy with a standardized mortality ratio greater than two. The cause of the increased mortality is yet to be definitively elucidated, but may be due to excess steroid exposure, or replacement regimens that are uncoupled from the normal physiological cortisol profile. Cortisol secretion follows an ultradian pattern which is not possible to reproduce using oral replacement. With the advent of new pumps, it is now possible to mimic the pulsatility of the adrenal glands. While the cognitive and emotional benefits of reproducing the ultradian rhythm are known, the presence of long-term benefits is not yet clear. There is a dearth of evidence and high-quality studies to underline our current understanding of the pathophysiology of adrenal insufficiency and replacement therapy. There is a particular lack of research comparing objective outcomes between patients receiving hydrocortisone replacement (either standard therapy or new sustained release preparations), prednisolone replacement and ultradian pumps. Direct comparative studies are now warranted to understand the optimal approach.
Substances chimiques
Glucocorticoids
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
367-371Subventions
Organisme : Department of Health
ID : DRF-2017-10-115
Pays : United Kingdom
Informations de copyright
© 2019 John Wiley & Sons Ltd.
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