[Adrenal Insufficiency]

Abstract

Even under established replacement therapy, chronic adrenal insufficiency is associated with an impairment in daily life activities and a higher number of sick-days. In patients with individually adjusted glucocorticoid doses (avoiding over-replacement) the frequency of glucocorticoid side effects is low. Besides the standard treatment with conventional hydrocortisone, new formulas aiming at more adjusted physiological circadian cortisol profiles or improved individual dosing have been evaluated in recent clinical trials. Adrenal crisis is a potential threat for patients with chronic adrenal insufficiency even under established hormone replacement therapy, which is triggered by infectious diseases mostly. Primary adrenal insufficiency, comorbidities and previous adrenal crisis were identified as risk factors. To improve the emergency-management in patients with adrenal insufficiency a nation-wide standardized education program for patients and relatives has been established in Germany. First results show an ongoing improvement of handling their sickness and certitude in patients with chronic adrenal insufficiency.