Management of endocrine disease: risk of overtreatment in patients with adrenal insufficiency: current and emerging aspects
Open accessAbstract
The effects of long-term replacement therapy of adrenal insufficiency (AI) are still a matter of controversy. In fact, the established glucocorticoid replacement regimens do not completely reproduce the endogenous hormonal production and the monitoring of AI treatment may be a challenge for the lack of reliable clinical and biochemical markers. Consequently, several AI patients are frequently exposed to relative glucocorticoid excess potentially leading to develop chronic complications, such as diabetes mellitus, dyslipidemia, hypertension and fragility fractures with consequent impaired QoL and increased mortality risk. This review deals with the pathophysiological and clinical aspects concerning the over-replacement therapy of primary and secondary AI.
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Overreplacement of glucocorticoids has been associated with increased mortality.
“Overreplacement of glucocorticoids has been associated with increased mortality (50), and under-replacement may lead to adrenal crises and hypoglycaemia.”
From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [50]
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Skeletal fragility induced by overtreatment of adrenal insufficiency
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Gaps in the management of adrenal insufficiency in melanoma survivors: a retrospective cohort study
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Nationellt miljökvalitetsmål på lokal nivå
Engkvist, F. (2011)
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Patro, P. M., & Rao, K. V. J. (2020) · Journal of Medical and Scientific Research · doi:10.17727/jmsr.2020/8s1-11
Nabi, T., Rafiq, N., Rahman, M. H. U., & Bhat, N. (2021) · Journal of Medical Sciences · doi:10.4103/jmedsci.jmedsci_298_20
Research Activities Calendar - Research Division
shecanip (2011)
Piccini, S., Ariano, S. A., Zucali, P. A., Vincenzo, F. D., Franzese, C., Scorsetti, M., Lania, A. G., & Mazziotti, G. (2022) · L Endocrinologo · doi:10.1007/s40619-022-01105-5
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Lastra, O. L. V., Navarro, A. O., Medina, G., Cruz-Domínguez, M. P., & Jara, L. J. (2023) · Elsevier eBooks · doi:10.1016/b978-0-443-18566-3.00001-3
Adrenal Insufficiency in ASEAN: Barriers and Variations in Diagnosis and ManagementPreprint
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Shrestha, E., Albert, S. G., Ghimire, A., Canales, S. P., Iqbal, I., & Akande, R. O. (2026) · AACE Endocrinology and Diabetes · doi:10.1016/j.aed.2026.03.001
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Chiloiro, S., Vicari, A., Giampietro, A., Costanza, F., Calandrelli, R., Mattogno, P. P., D’Alessandris, Q. G., Gaudino, S., Marinis, L. D., Doglietto, F., et al. (2026) · Pituitary · doi:10.1007/s11102-026-01726-1
NING, C., Zhang, R., Liu, W., Zhou, X., Sun, Y., Han, X., Ji, L., & Ren, Q. (2026) · Endocrine Connections · doi:10.1530/ec-26-0304
- Authors
- Mazziotti, G., Formenti, A. M., Frara, S., Roca, E., Mortini, P., Berruti, A., & Giustina, A.
- Affiliations
- Azienda Ospedaliera Carlo Poma (IT)
- University of Brescia (IT)
- Vita-Salute San Raffaele University (IT)
- Corresponding author
- Giustina, A
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-11
- Volume
- 177
- Issue
- 5
- Pages
- R231-R248
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2622070501
- Cited by
- 96
- References
- 155
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 16 · 2023: 7 · 2022: 15 · 2021: 13 · 2020: 13 · 2019: 4 · 2018: 10 · 2017: 2
- FWCI
- 1.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- adrenal insufficiency, glucocorticoid replacement therapy, overtreatment, glucocorticoid excess, Addison's disease, secondary adrenal insufficiency, diabetes mellitus, dyslipidemia, hypertension, fragility fractures, quality of life, mortality risk, treatment monitoring
- MeSH terms
- Medical Overuse, Adrenal Insufficiency, Humans, Hydrocortisone, Risk Factors, Disease Management, Hormone Replacement Therapy
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