Adrenal insufficiency is a deadly disorder. Studies on the outcome of patients with adrenal insufficiency may have been hampered by the dramatic improvement in mortality and morbidity that occurred when synthetic glucocorticoids came available more than 60 years ago. Studies during the last 17 years have repeatedly shown that mortality rate in patients with hypopituitarism is doubled. The presence of adrenal insufficiency in hypopituitarism in young adults with childhood-onset disease has been associated with increased mortality rate, but not in adults with adult-onset disease. In patients with primary adrenal insufficiency survival rate has been considered to be normal. Recent data, however, suggest that these patients may have excess mortality due to cardiovascular-, infectious diseases and malignancy. Studies on morbidity in patients with primary adrenal insufficiency are few with some indicating impaired glucose tolerance, reduced bone mineral density and impaired QoL and well-being. Current strategy for glucocorticoid replacement therapy is based on 23 administrations of short-acting hydrocortisone or the administration of a more long acting synthetic glucocorticoid. Historically overly high daily doses of glucocorticoids for replacement may have caused metabolic and catabolic side-effects. The increased mortality due to infectious disorders also suggests inadequate replacement therapy under such circumstances. The impact of an unphysiological diurnal exposure of glucocorticoids with current replacement strategy is less clear. Producing a more physiological serum cortisol curve have in some studies improved well being either by increasing the frequency of oral hydrocortisone administration or by using a continuous infusion of hydrocortisone. Recent attempts have also been made to include hydrocortisone into novel drug delivery techniques making the diurnal exposure of cortisol more physiological. Also, delivery systems allowing once-daily administration simplify treatment and should thereby improve compliance with possible beneficial effects on short- and long-term outcome in adrenal insufficiency.
03 - 07 May 2008
European Society of Endocrinology