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Cited by 122Adrenal Hormones and DisordersStress Responses and CortisolHormonal Regulation and Hypertension

Adrenal insufficiency: review of clinical outcomes with current glucocorticoid replacement therapy

Johannsson, Gudmundur, Falorni, Alberto, Skrtic, Stanko, Lennernäs, Hans, Quinkler, Marcus, Monson, John P., Stewart, Paul M.·2015·Clinical Endocrinology
DOI 10.1111/cen.12603
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Abstract

Summary: Glucocorticoid replacement therapy in patients with adrenal insufficiency ( AI ), whether primary ( A ddison's disease) or secondary (due to hypopituitarism), has been established for some 50 years. The current standard treatment regimen involves twice‐ or thrice‐daily dosing with a glucocorticoid, most commonly oral hydrocortisone. Based on previous small‐scale studies and clinical perception, life expectancy with conventional glucocorticoid replacement therapy has been considered normal, with a low incidence of adverse events. Data from the past 10–15 years, however, have shown that morbidity remains high and life expectancy is reduced. The increased morbidity and decreased life expectancy appear to be due to both increased exposure to cortisol and insufficient cortisol coverage during infections and other stress‐related events. This is thought to reflect a failure of treatment to replicate the natural circadian rhythm of cortisol release, together with a failure to identify and deliver individualized cortisol exposure and to manage patients adequately when increased doses are required. The resulting over‐ or under‐treatment may result in Cushing‐like symptoms or adrenal crisis, respectively. This review summarizes the morbidity and mortality seen in patients receiving the current standard of care for AI and suggests areas for improvement in glucocorticoid replacement therapy.

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Crossref · 10.1111/cen.12603

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  • Treatment effectiveness in children with PAI must be carefully monitored by clinical evaluation of growth velocity, weight, blood pressure and energy status every 3 to 6 months.

    “Treatment effectiveness in children with PAI must be carefully monitored by clinical evaluation of growth velocity, weight, blood pressure and energy status every 3 to 6 months (39).”

    From X-linked adrenoleukodystrophy and primary adrenal insufficiency (2023) · cites this paper as [39]

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Authors
Johannsson, G., Falorni, A., Skrtic, S., Lennernäs, H., Quinkler, M., Monson, J. P., & Stewart, P. M.
Affiliations
  • University of Gothenburg (SE)
  • University of Perugia (IT)
  • AstraZeneca (Sweden) (SE)
  • Uppsala University (SE)
  • Endocrinology in Charlottenburg Berlin Germany
  • Queen Mary University of London (GB)
  • University of Leeds (GB)
Corresponding author
Johannsson, Gudmundur
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2014-10-10
Volume
82
Issue
1
Pages
2-11
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/cen.12603
OpenAlex
W2082493231
Cited by
122
References
12
Citations by year
2026: 5 · 2025: 10 · 2024: 13 · 2023: 11 · 2022: 4 · 2021: 13 · 2020: 10 · 2019: 14 · 2018: 7 · 2017: 15 · 2016: 14 · 2015: 5 · 2014: 1
FWCI
1.86
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Viropharma
  • National Institute for Health and Care Research (NF-SI-0508-10356)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords
adrenal insufficiency, glucocorticoid replacement therapy, cortisol, Addison's disease, hypopituitarism, life expectancy, morbidity and mortality, diurnal cortisol rhythm, adrenal crisis, stress dosing, treatment adequacy
MeSH terms
Adrenal Insufficiency, Glucocorticoids, Humans, Treatment Outcome, Hormone Replacement Therapy

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