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. 2019 Oct:8:152-159.
doi: 10.1016/j.coemr.2019.08.011. Epub 2019 Sep 4.

Glucocorticoid replacement therapies: past, present and future

Su-Yi Liew  1 , Scott A Akker  1 , Leonardo Guasti  1 , James F H Pittaway  1
Affiliations

Glucocorticoid replacement therapies: past, present and future

Su-Yi Liew et al. Curr Opin Endocr Metab Res. 2019 Oct.

Abstract

Since the original description of adrenal insufficiency by Thomas Addison in 1855, there has been an exponential growth in the understanding of adrenal gland biology and its role in the hypothalamic-pituitary-adrenal axis. Despite this, the mainstay of therapeutic glucocorticoid replacement for most clinicians has remained unchanged for nearly 50 years. More recently, there has been better recognition of the morbidity and mortality associated with current approaches and the challenges to tackle in reducing this and improving clinical outcomes. In this review, we have summarised the history of glucocorticoid replacement therapy from its nascence in the 1930s, through common practice and culminating in more recent glucocorticoid replacement strategies plus the potential of stem cell therapy in the future.

Keywords: Adrenal insufficiency; Glucocorticoid; Regenerative medicine; Stem cell.

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Conflict of interest statement

Conflict of interest statement Nothing declared.

Figures

Figure 1
Figure 1
Glucocorticoid replacement therapy: past, present and future. (a) Photograph of Thomas Addison (Credit: Wellcome Collection. CC BY) and illustration of his seminal manuscript. (b) Diagram of the structure of corticosterone (compound E). (c) Illustration of the circadian rhythmicity of cortisol levels. (d) Illustration of potential future avenues for replacing adrenocortical function using stem cell/regenerative medicine.
Figure 2
Figure 2
Timeline of glucocorticoid replacement therapy through the ages. An illustration of the key events in the chronology of glucocorticoid replacement. AI, adrenal insufficiency; GC, glucocorticoid.
See this image and copyright information in PMC

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