Endocrine Abstracts

For a long time it has been assumed that patients with adrenal insufficiency (AI) can live without any restriction when receiving standard hormone replacement therapy.

However, recent evidence indicates that subjective health status (SHS) in patients with primary adrenal insufficiency is significantly impaired at least in a subgroup of patients and that mortality is increased compared to the general population.

The observation of impaired SHS holds true for patients with both primary and secondary AI and also for patients with congenital hyperplasia. It is reflected by a high proportion of occupational changes and restriction of leisure time activities. The non-physiological cortisol profile achieved by standard replacement strategies has been particularly claimed as main cause for the reduced SHS but also lack of further hormones like DHEA and epinephrine might be an underlying cause. Recent efforts aim at improving replacement strategies by mimicking a more physiological cortisol profile and to restore androgen deficiency and new therapeutic options have emerged.

The observation of increased mortality has led to more detailed studies demonstrating that adrenal insufficiency per se represents one of the most common causes of death in this patient population but also death from infectious disease and cardiovascular disease appears to be increased. Adrenal crisis is more frequent than suggested by earlier analyses, even in well educated patients. Both physical and psychological distress may precipitate adrenal crisis with infectious disease being the most frequent precipitating factor. The relative risk to die from infectious disease is largely increased, suggesting that many of these patients are not sufficiently treated resulting in adrenal crisis. Recent activities aim at an improved and standardized patient education and an improvement of awareness in health professionals.

In conclusion both, replacement strategies in chronic AI and prevention and treatment of adrenal crisis deserve particular attention and need to be further improved.