Cargando…
Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency
Adrenal insufficiency is defined as impaired adrenocortical hormone synthesis. According to its source, the deficit is classified as primary (adrenal steroidogenesis impairment), secondary (pituitary adrenocorticotropic hormone deficit) or tertiary (hypothalamic corticotropin-releasing hormone defic...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360643/ https://www.ncbi.nlm.nih.gov/pubmed/30746120 http://dx.doi.org/10.1177/2042018818821294 |
_version_ | 1783392537700990976 |
---|---|
author | Oprea, Alina Bonnet, Nicolas C. G. Pollé, Olivier Lysy, Philippe A. |
author_facet | Oprea, Alina Bonnet, Nicolas C. G. Pollé, Olivier Lysy, Philippe A. |
author_sort | Oprea, Alina |
collection | PubMed |
description | Adrenal insufficiency is defined as impaired adrenocortical hormone synthesis. According to its source, the deficit is classified as primary (adrenal steroidogenesis impairment), secondary (pituitary adrenocorticotropic hormone deficit) or tertiary (hypothalamic corticotropin-releasing hormone deficit). The management of adrenal insufficiency resides primarily in physiological replacement of glucocorticoid secretion. Standard glucocorticoid therapy is shrouded in several controversies. Along the difficulties arising from the inability to accurately replicate the pulsatile circadian cortisol rhythm, come the uncertainties of dose adjustment and treatment monitoring (absence of reliable biomarkers). Furthermore, side effects of inadequate replacement significantly hinder the quality of life of patients. Therefore, transition to circadian hydrocortisone therapy gains prominence. Recent therapeutic advancements consist of oral hydrocortisone modified-release compounds (immediate, delayed and sustained absorption formulations) or continuous subcutaneous hydrocortisone infusion. In addition to illustrating the current knowledge on conventional glucocorticoid regimens, this review outlines the latest research outcomes. We also describe the management of pediatric patients and suggest a novel strategy for glucocorticoid replacement therapy in adults. |
format | Online Article Text |
id | pubmed-6360643 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-63606432019-02-11 Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency Oprea, Alina Bonnet, Nicolas C. G. Pollé, Olivier Lysy, Philippe A. Ther Adv Endocrinol Metab Review Adrenal insufficiency is defined as impaired adrenocortical hormone synthesis. According to its source, the deficit is classified as primary (adrenal steroidogenesis impairment), secondary (pituitary adrenocorticotropic hormone deficit) or tertiary (hypothalamic corticotropin-releasing hormone deficit). The management of adrenal insufficiency resides primarily in physiological replacement of glucocorticoid secretion. Standard glucocorticoid therapy is shrouded in several controversies. Along the difficulties arising from the inability to accurately replicate the pulsatile circadian cortisol rhythm, come the uncertainties of dose adjustment and treatment monitoring (absence of reliable biomarkers). Furthermore, side effects of inadequate replacement significantly hinder the quality of life of patients. Therefore, transition to circadian hydrocortisone therapy gains prominence. Recent therapeutic advancements consist of oral hydrocortisone modified-release compounds (immediate, delayed and sustained absorption formulations) or continuous subcutaneous hydrocortisone infusion. In addition to illustrating the current knowledge on conventional glucocorticoid regimens, this review outlines the latest research outcomes. We also describe the management of pediatric patients and suggest a novel strategy for glucocorticoid replacement therapy in adults. SAGE Publications 2019-02-02 /pmc/articles/PMC6360643/ /pubmed/30746120 http://dx.doi.org/10.1177/2042018818821294 Text en © The Author(s), 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Review Oprea, Alina Bonnet, Nicolas C. G. Pollé, Olivier Lysy, Philippe A. Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency |
title | Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency |
title_full | Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency |
title_fullStr | Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency |
title_full_unstemmed | Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency |
title_short | Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency |
title_sort | novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360643/ https://www.ncbi.nlm.nih.gov/pubmed/30746120 http://dx.doi.org/10.1177/2042018818821294 |
work_keys_str_mv | AT opreaalina novelinsightsintoglucocorticoidreplacementtherapyforpediatricandadultadrenalinsufficiency AT bonnetnicolascg novelinsightsintoglucocorticoidreplacementtherapyforpediatricandadultadrenalinsufficiency AT polleolivier novelinsightsintoglucocorticoidreplacementtherapyforpediatricandadultadrenalinsufficiency AT lysyphilippea novelinsightsintoglucocorticoidreplacementtherapyforpediatricandadultadrenalinsufficiency |