ECE2015 Symposia Adrenal insufficiency: advances in diagnostics and therapy (<emphasis role="italic">Endorsed by the European Journal of Endocrinology</emphasis>) (3 abstracts)
Newcastle University, Newcastle upon Tyne, UK.
It is obvious that adrenal cortex is plastic, with adrenal atrophy and functional hypoadrenalism during exogenous glucocorticoid therapy; yet adrenal hyperplasia and hyperfunction during stimulation from ACTH during Cushings disease. This is owing to subcapsular adrenocortical stem cells that regenerate the zones of adult adrenal cortex throughout life.
We have performed a series of experimental medicine trials in order to explore the idea that autoimmune Addisons disease may therefore be remediable. These studies have used either immunomodulation with B lymphocyte depletion therapy, high-dose ACTH analogue or both, in order to try to modify the natural history of the condition. In summary, there are a proportion of people (~20%) with both newly diagnosed and established autoimmune Addisons disease who have some degree of residual adrenal function. In a few people we have induced a durable, steroid medication-free remission of Addisons disease which has lasted from 6 months to as long as 4 years and ongoing. This opens a window for further regenerative medicine strategies to ameliorate adrenal failure in this patient group.