title: Therapy of endocrine disease: Perspectives on the management of adrenal insufficiency: clinical insights from across Europe.
abstract: BACKGROUND
  Conventional glucocorticoid (GC) replacement for patients with adrenal insufficiency (AI) is inadequate. Patients with AI continue to have increased mortality and morbidity and compromised quality of life despite treatment and monitoring.
  
  
  OBJECTIVE
  i) To review current management of AI and the unmet medical need based on literature and treatment experience and ii) to offer practical advice for managing AI in specific clinical situations.
  
  
  METHODS
  The review considers the most urgent questions endocrinologists face in managing AI and presents generalised patient cases with suggested strategies for treatment.
  
  
  RESULTS
  Optimisation and individualisation of GC replacement remain a challenge because available therapies do not mimic physiological cortisol patterns. While increased mortality and morbidity appear related to inadequate GC replacement, there are no objective measures to guide dose selection and optimisation. Physicians must rely on experience to recognise the clinical signs, which are not unique to AI, of inadequate treatment. The increased demand for corticosteroids during periods of stress can result in a life-threatening adrenal crisis (AC) in a patient with AI. Education is paramount for patients and their caregivers to anticipate, recognise and provide proper early treatment to prevent or reduce the occurrence of ACs.
  
  
  CONCLUSIONS
  This review highlights and offers suggestions to address the challenges endocrinologists encounter in treating patients with AI. New preparations are being developed to better mimic normal physiological cortisol levels with convenient, once-daily dosing which may improve treatment outcomes.
authors.affiliation: Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, University of Oxford, Headington, Oxford OX3 7EJ, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Grossman
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Johannsson
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
authors.forename: Pierre
authors.initials: P
authors.lastname: Zelissen
mesh_terms: D000224:Addison Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000309:Adrenal Insufficiency / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000209:etiology; D002940:Circadian Rhythm; D003687:Dehydroepiandrosterone / Q000008:administration & dosage / Q000627:therapeutic use*; D048909:Diabetes Complications / Q000188:drug therapy; D004334:Drug Administration Schedule; D015195:Drug Design; D015507:Drugs, Investigational; D004638:Emergency Treatment / Q000379:methods; D005060:Europe; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D007037:Hypothyroidism / Q000150:complications; D007275:Injections, Intravenous; D008297:Male; D008901:Mineralocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015507:Drugs, Investigational; D005938:Glucocorticoids; D008901:Mineralocorticoids; D003687:Dehydroepiandrosterone; D006854:Hydrocortisone
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