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Management of patients with glucocorticoid deficiency

Nature Clinical Practice Endocrinology & Metabolism volume 1, pages 62–63 (2005)Cite this article

Thomas Addison, who first described “the constitutional and local effects of disease of the suprarenal capsules” in 1849, said he feared the disease was irremediable.1 In the 21st century, we assume that mortality in patients treated for autoimmune Addison's disease is not increased when compared to the general population, and the death rate of patients with hypopituitarism treated for secondary hypoadrenalism does not differ from those without adrenocorticotropic hormone deficiency.2 Mortality rates, however, are not the whole story. Many patients perceive that their health is impaired, and report fatigue and reduced vitality compared with the general population.3 As we understand more about the physiology of glucocorticoid production, it becomes clear that current treatment regimens do not reproduce normal physiology, so perhaps it is unsurprising that patients report an impaired quality of life. The data challenge us to respond and translate this knowledge into improved patient care.

Historically, patients with hypoadrenalism have received high daily doses of glucocorticoids, equivalent to 30 mg hydrocortisone or more. In two studies using different experimental methods,4,5 the normal daily cortisol production rate was found to be lower than previously thought, at approximately 10 mg (5.7 mg/m2), suggesting that many patients were receiving chronic over-replacement. The multiple adverse effects of long-term treatment with high, pharmacologic doses of glucocorticoid are well recognized. We know much less about whether similar problems are associated with minor over-replacement, because data have been gleaned from studies examining the effect of different replacement regimens on osteoporosis and cardiovascular disease in small populations assessing surrogate markers of these outcomes.

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Authors and Affiliations

  1. University of Bristol and a Specialist Registrar in Endocrinology and Diabetes,

    Anna Crown & Stafford Lightman

  2. University of Bristol and the Director of the Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Bristol, UK

    Anna Crown & Stafford Lightman

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  1. Anna Crown
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  2. Stafford Lightman
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Correspondence to Stafford Lightman.

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The authors declare no competing financial interests.

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Crown, A., Lightman, S. Management of patients with glucocorticoid deficiency. Nat Rev Endocrinol 1, 62–63 (2005). https://doi.org/10.1038/ncpendmet0051

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