ADRENAL INSUFFICIENCY: CURRENT THERAPEUTIC REPLACEMENT STRATEGIES. IS THERE ANY EVIDENCE OF IMPROVED CLINICAL OUTCOMES WITH THE USE OF ONCE DAILY LONG ACTING HYDROCORTISONE THERAPY?
Dr. Mustafa Al-Abousi*
ABSTRACT
Adrenal insufficiency can be subdivided into three broad categories: (1) Chronic primary adrenal insufficiency,
also called Addison's disease, in which autoimmune adrenalitis is the most frequent cause (Carey RM 1997). (2)
Chronic secondary adrenal insufficiency is most frequently caused by hypothalamic-pituitary tumors (3) acute
adrenal crisis may result from stress in patients with chronic adrenal insufficiency who are not adequately
replaced, but it also occurs in patients with acute adrenal hemorrhage or pituitary apoplexy (Yoram Shenker
2001). Chronic replacement therapy with glucocorticoids and, in primary adrenal insufficiency, mineralocorticoids
requires careful monitoring. However, current replacement strategies still require optimization as evidenced by
recent studies demonstrating significantly impaired subjective health status and increased mortality due to
inappropriate GC replacement therapy in patients with primary and secondary adrenal insufficiency (ArltW2009).
Further studies have explored the potential of modified delayed-release hydrocortisone to improve the prospects of
patients with adrenal insufficiency.
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