Endocrine Abstracts

Primary adrenal insufficiency (PAI) is relatively straightforward to diagnose. However, the challenge lies in considering it as a differential diagnosis due to its rarity, the gradual onset of symptoms, and the nonspecific and common nature of these symptoms. Even with optimal corticosteroid replacement therapy, patients with adrenal insufficiency often report a diminished quality of life (QoL), and studies indicate increased mortality and morbidity. Identifying the underlying cause of adrenal insufficiency is crucial, as it can have significant prognostic and therapeutic implications. For instance, patients with an autoimmune etiology are at a heightened risk for developing additional autoimmune diseases. Conventional hydrocortisone formulations have short half-lives of approximately 90 minutes, necessitating multiple doses throughout the day. Newer treatment modalities, such as extended-release hydrocortisone formulations and subcutaneous pump therapy, have shown promise in selected patients. A key challenge in managing PAI is the need to individualize replacement therapy to closely mimic physiological conditions, thereby optimizing therapeutic effects while preventing complications related to over- or underreplacement. Currently, the absence of sensitive biomarkers for assessing glucocorticoid effects in the clinical settings hinders treatment optimization. Effective management also requires the physician to take into account the patient’s age, occupation, and living conditions. Additionally, patient education on self-management and emergency preparedness is a critical component of care.