• Der Internist · Jan 2022

    Review

    [New aspects of glucocorticoid substitution in adrenal insufficiency].

    • Tina Kienitz and Gesine Meyer.
    • Endokrinologie in Charlottenburg, Stuttgarter Platz 1, 10627, Berlin, Deutschland. tina.kienitz@gmail.com.
    • Internist (Berl). 2022 Jan 1; 63 (1): 12-17.

    BackgroundAppropriate glucocorticoid dose adjustment in specific situations significantly impacts quality of life and performance of patients with adrenal insufficiency. It is also pivotal for the prevention of adrenal crisis.ObjectivesImproving medical care for patients with adrenal insufficiency.Materials And MethodsSelective literature research focussing on the most recent studies.ResultsOptimal glucocorticoid substitution aims at closely mimicking physiological fluctuations of cortisol levels. In recent years glucocorticoid preparations with modified pharmacokinetics have expanded the therapeutic arsenal. Adrenal crises occur with an incidence of 4.8-9.3 crises per 100 patient years. With a mortality of 0.5 per 100 patient years adrenal crisis is a life-threatening event. Therefore, it is of the utmost importance to adjust glucocorticoid dose in situations with increased cortisol demand in order to prevent as well as appropriately treat adrenal crisis.ConclusionsTo prevent life-threatening adrenal crisis, patients, their families and medical staff require training.© 2021. The Author(s).

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