Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Adrenal disease

Imitating the cortisol profile improves the immune system

A once-daily, modified-release hydrocortisone medication reduces BMI and improves glucose metabolism compared with the twice- or thrice-daily standard hydrocortisone treatment in patients with adrenal insufficiency. Now, further evidence emerges that changing to a once-daily, modified-release hydrocortisone medication improves the immune cell profile and results in fewer infections.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Isidori, A. M. et al. Effect of once-daily, modified-release hydrocortisone versus standard glucocorticoid therapy on metabolism and innate immunity in patients with adrenal insufficiency (DREAM): a single-blind, randomised controlled trial. Lancet Diabetes Endocrinol. https://doi.org/10.1016/S2213-8587(17)30398-4 (2017).

  2. Johannsson, G. et al. Improved cortisol exposure-time profile and outcome in patients with adrenal insufficiency: a prospective randomized trial of a novel hydrocortisone dual-release formulation. J. Clin. Endocrinol. Metab. 97, 473–481 (2012).

    Article  CAS  Google Scholar 

  3. Quinkler, M. et al. Modified-release hydrocortisone decreases BMI and HbA1c in patients with primary and secondary adrenal insufficiency. Eur. J. Endocrinol. 172, 619–626 (2015).

    Article  CAS  Google Scholar 

  4. Giordano, R. et al. Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison's disease. Endocrine 51, 360–368 (2016).

    Article  CAS  Google Scholar 

  5. Bancos, I. et al. Primary adrenal insufficiency is associated with impaired natural killer cell function: a potential link to increased mortality. Eur. J. Endocrinol. 176, 471–480 (2017).

    Article  CAS  Google Scholar 

  6. Oksnes, M. et al. Continuous subcutaneous hydrocortisone infusion versus oral hydrocortisone replacement for treatment of addison's disease: a randomized clinical trial. J. Clin. Endocrinol. Metab. 99, 1665–1674 (2014).

    Article  Google Scholar 

  7. Coles, A. J. et al. Dehydroepiandrosterone replacement in patients with Addison's disease has a bimodal effect on regulatory (CD4+CD25hi and CD4+FoxP3+) T cells. Eur. J. Immunol. 35, 3694–3703 (2005).

    Article  CAS  Google Scholar 

  8. Behan, L. A. et al. Optimizing glucocorticoid replacement therapy in severely adrenocorticotropin-deficient hypopituitary male patients. Clin. Endocrinol. 75, 505–513 (2011).

    Article  CAS  Google Scholar 

  9. Sherlock, M. et al. The modulation of corticosteroid metabolism by hydrocortisone therapy in patients with hypopituitarism increases tissue glucocorticoid exposure. Eur. J. Endocrinol. 173, 583–593 (2015).

    Article  CAS  Google Scholar 

  10. Quinkler, M. et al. Prednisolone is associated with a worse lipid profile than hydrocortisone in patients with adrenal insufficiency. Endocr. Connect. 6, 1–8 (2017).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marcus Quinkler.

Ethics declarations

Competing interests

M.Q. received honoraria for talks and consultancy from Viropharma/Shire.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Müller, L., Quinkler, M. Imitating the cortisol profile improves the immune system. Nat Rev Endocrinol 14, 137–139 (2018). https://doi.org/10.1038/nrendo.2018.5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrendo.2018.5

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing