Endocrine Abstracts

Primary adrenal insufficiency is often a consequence of autoimmune destruction of the adrenal cortex. Mortality is increased primarily due to acute adrenal crises, especially among patients diagnosed at young age. In the long-term more than 50% of the patients will develop other autoimmune diseases or manifestations, particularly autoimmune thyroid disease. Despite seemingly adequate treatment, accumulating evidence document reduced subjective health status, particularly general health and vitality, and physical functioning in women. Working ability is also reduced. However, sexual function in women seems to be normal despite lack of androgens.

Replacement therapy with glucocorticoids and mineralocorticoids is standard, but we lack effect parameters to guide treatment. Thus there is risk for long-term metabolic consequences on glucose regulation, cardiovascular function, and bone.

There is a need to determine the long-term consequences of the replacement therapy, and to provide individualised and more physiological treatment. Slow-release preparations of hydrocortisone may become the mainstay therapy, and continuous subcutaneous hydrocortisone infusion an alternative for selected patients.