Metabolic comorbidities of adrenal insufficiency: Focus on steroid replacement therapy and chronopharmacology

AbstractGreat heterogeneity seems to exist regarding diagnosis, therapy, and teaching of patients with secondary adrenal insufficiency (SAI) across Germany resulting in different diagnosis and treatment strategies. The aim of the work was to present the first national audit on diagnosis, treatment, and patient teaching of SAI reflecting common clinical practice in Germany. A self-designed questionnaire was sent via e-mail to all members of the German Endocrine Society (approx. 120 centers). Returned questionnaires (response rate 38.3%) were checked for duplicity of institutions and analyzed. Diagnostic testing focuses on those patients with relevant risk for adrenal insufficiency. Basal serum cortisol is mostly used as screening test. Short synacthen and CRH tests are the preferred confirmatory tests, however, cut-off values vary due to different assays used. Patients with radiation, second surgery, progressive disease or new symptoms are followed by serial re-testing. Perioperative management and frequency of postoperative re-evaluations differ among centers. Hydrocortisone is the preferred glucocorticoid for replacement therapy, but daily doses vary considerably (10–30 mg/day). Some centers perform hormone measurements for dose adjustment of glucocorticoid replacement therapy whereas others rely on clinical judgement. Patients’ teaching is done in 84% of centers, but only half of the centers include patients’ relatives. Homogeneity exists in patients’ teaching regarding intercurrent illnesses (fever, diarrhoea). Recommendations regarding dose adaptations in situations such as sport-activities, dental-procedures, or coughing are highly variable. This first national audit reveals great heterogeneity among German centers and could improve patients’ care in SAI, for example, by initiating new trials and developing clinical practice guidelines.

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Beneficial effects of replacement therapy with modified-release hydrocortisone in patients with adrenal insufficiency

Endocrine Abstracts ◽

10.1530/endoabs.37.ep53 ◽

2015 ◽

Author(s):

Valentina Morelli ◽

Erika Messina ◽

Marco Mendola ◽

Elisa Cairoli ◽

Bruno Ambrosi ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Replacement Therapy ◽

Modified Release ◽

Beneficial Effects

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Introduction: Patients with primary adrenal insufficiency receive long - term glucocorticoid replacement therapy, which may cause osteoporosis

Vnitřní lékařství ◽

10.36290/vnl.2021.073 ◽

2021 ◽

Vol 67 (5) ◽

pp. 264-269

Author(s):

Peter Vaňuga ◽

Ivana Ságová

Keyword(s):

Adrenal Insufficiency ◽

Replacement Therapy ◽

Primary Adrenal Insufficiency ◽

Glucocorticoid Replacement Therapy

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Acute Primary Adrenal Insufficiency after Hip Replacement in a Patient with Acute Intermittent Porphyria

Case Reports in Endocrinology ◽

10.1155/2018/2353172 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Adele Latina ◽

Massimo Terzolo ◽

Anna Pia ◽

Giuseppe Reimondo ◽

Elena Castellano ◽

...

Keyword(s):

Postmenopausal Woman ◽

Adrenal Insufficiency ◽

Replacement Therapy ◽

Genetic Disease ◽

Hip Replacement ◽

Acute Intermittent Porphyria ◽

Adrenal Hemorrhage ◽

Primary Adrenal Insufficiency ◽

Threatening Condition ◽

Life Threatening

Adrenal insufficiency is a potentially life-threatening condition when it occurs acutely, as in adrenal hemorrhage. Generally it is not reversible and requires chronic replacement therapy. Acute intermittent porphyria (AIP) is a rare genetic disease characterized by alterations in heme biosynthesis that result in accumulation of precursors in tissues. A crisis can be triggered by many conditions such as surgery and infections. Symptoms are similar to those of acute hypoadrenalism. Moreover, both conditions are characterized by hyponatremia. We describe the case of a postmenopausal woman known to be affected by AIP who developed after surgery a primary adrenal insufficiency associated with adrenal enlargement; the latter completely reverted in six months.

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Therapeutic Patient Education for Adrenal Insufficiency under COVID-19 Pandemic Conditions

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1217-7208 ◽

2020 ◽

Author(s):

Tina Kienitz ◽

Stefanie Hahner ◽

Stephanie Burger-Stritt ◽

Marcus Quinkler

Keyword(s):

Patient Education ◽

Adrenal Insufficiency ◽

Replacement Therapy ◽

Medical Therapy ◽

Medical Personnel ◽

Daily Basis ◽

Background Information ◽

Therapeutic Patient Education ◽

Dose Adaptation ◽

Glucocorticoid Replacement Therapy

AbstractAdrenal insufficiency (AI) requires life-long treatment with glucocorticoid replacement therapy. Over- or under-substitution carries the risk of increased morbidity in the form of side effects or adrenal crises. Glucocorticoid replacement therapy needs to be flexible with dose adaptation in special situations. This could not be managed by medical personnel on a daily basis, but requires an educated patient who has a good knowledge of the disease, understands his medical therapy and is able to perform situational dose adaptation. The rarity of the disease in combination with the need to respond to stressful situations with rapid glucocorticoid dose adjustment underlines that a well-trained patient is crucial for optimal management of the disease.In this literature review we provide background information further clarifying the need of education in patients with AI including the current shortcomings of medical therapy and of the treatment of patients with AI. We outline the aims of therapeutic patient education, present the concept of structured patient education in Germany, and discuss available results of patient group education programs. Furthermore, we propose strategies how therapeutic patient education for adrenal insufficiency can be organized under COVID-19 pandemic conditions.

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Increased Cardiovascular Risk in Patients with Adrenal Insufficiency: A Short Review

BioMed Research International ◽

10.1155/2017/3691913 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 10

Author(s):

Amir-Hossein Rahvar ◽

Christian S. Haas ◽

Sven Danneberg ◽

Birgit Harbeck

Keyword(s):

Cardiovascular Risk ◽

Adrenal Insufficiency ◽

Replacement Therapy ◽

Interleukin 1 ◽

Short Review ◽

Blood Levels ◽

Increased Risk ◽

The World ◽

Coronary Events ◽

Necrosis Factor

Cardiovascular disease (CVD) is the most common cause of death in the world. Recent studies have shown an association between adrenal insufficiency (AI) and increased cardiovascular risk (CVR). Patients with AI receive glucocorticoid (GC) replacement therapy which can lead to varying levels of blood cortisol. It was shown that these imbalances in blood cortisol may lead to a higher prevalence of coronary heart disease, major adverse coronary events, and increased mortality. GC substitution is essential in the treatment of AI without which the disease has been shown to be fatal. The most frequently used GC formula for replacement therapy is hydrocortisone (HC). There is no uniform opinion on hydrocortisone replacement therapy. Alternative GC such as prednisolone is also in use. Overreplacement of GC may lead to adverse effects including obesity, high blood pressure, and hyperglycaemia. Outcome may vary between primary and secondary AI mainly due to differences in the renin-angiotensin-aldosterone system (RAAS). Furthermore, decreased blood levels of cortisol may lead to a compensatory secretion of inflammatory mediators such as Interleukin-1 (IL-1), Interleukin-6 (IL-6), and/or tumor-necrosis factor (TNF). Physicians and patients should be properly educated about the increased risk of CVD in patients with AI.

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