Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

ERS Congress 2024

Keep up to date on the latest news from the annual European Respiratory Society conference.
ADVANCED SEARCH
Log in
Top
Reviews in Endocrine and Metabolic Disorders

Open Access 22-08-2024 | Hypothalamic Pituitary Adrenal Axis Dysfunction

Effects of glucocorticoid replacement therapy in patients with pituitary disease: A new perspective for personalized replacement therapy

Authors: Sabrina Chiloiro, Alessandra Vicari, Ginevra Mongelli, Flavia Costanza, Antonella Giampietro, Pier Paolo Mattogno, Liverana Lauretti, Alessandro Olivi, Laura De Marinis, Francesco Doglietto, Antonio Bianchi, Alfredo Pontecorvi

Published in: Reviews in Endocrine and Metabolic Disorders

Login to get access

Abstract

Secondary adrenal insufficiency (SAI) is an endocrine disorder due to impaired secretion of ACTH resulting from any disease affecting the pituitary gland. Glucocorticoid replacement therapy is mandatory to ensure patient survival, haemodynamic stability, and quality of life. In fact, a correct dose adjustement is mandatory due to the fact that inappropriately low doses expose patients to hypoadrenal crisis, while inappropriately high doses contribute to glucose metabolic and cardiovascular deterioration. This review analyses the current evidence from available publications on the epidemiology and aetiology of SAI and examines the association between glucocorticoid replacement therapy and glucometabolic and cardiovascular effects.
Literature
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Connell JM, Whitworth JA, Davies DL, et al. Effects of ACTH and cortisol administration on blood pressure, electrolyte metabolism, atrial natriuretic peptide and renal function in normal man. 1987;5:425–433.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Dineen RA, Martin-Grace J, Ahmed KMS, Taylor AE, Shaheen F, Schiffer L, Gilligan LC, Lavery GG, Frizelle I, Gunness A, Garrahy A, Hannon AM, Methlie P, Eystein SH, Stewart PM, Tomlinson JW, Hawley JM, Keevil BG, O’Reilly MW, Smith D, McDermott J, Healy ML, Agha A, Pazderska A, Gibney J, Behan LA, Thompson CJ, Arlt W, Sherlock M. Tissue glucocorticoid metabolism in adrenal insufficiency: A prospective study of dual-release hydrocortisone therapy. 2023. https://​doi.​org/​10.​1210/​clinem/​dgad370.CrossRef
32.
Frara S, Chiloiro S, Porcelli T, et al. Bone safety of dual-release hydrocortisone in patients with hypopituitarism. 2018;60:528.
33.
34.
35.
36.
Nowotny H, Ahmed SF, Bensing S, Beun JG, Brösamle M, Chifu I, Claahsen van der Grinten H, Clemente M, Falhammar H, Hahner S, Husebye E, Kristensen J, Loli P, Lajic S, Reisch N, Endo ERN (MTG1). Therapy options for adrenal insufficiency and recommendations for the management of adrenal crisis. 2021. https://​doi.​org/​10.​1007/​s12020-021-02649-6.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
Pilli T, Cardinale S, Cantara S, Dalmazio G, Forleo R, Capezzone M, Bassi C, Negrini M, Ferracin M, Castagna MG. Preliminary results from whole-genome expression analysis in patients with secondary adrenal insufficiency treated with modified-release hydrocortisone. 2021. https://​doi.​org/​10.​1007/​s12020-020-02578-w.CrossRef
51.
52.
53.
Chung TT, Monson JP. Hypopituitarism. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. 2022. PMID: 25905222.
54.
55.
56.
Rindi G, Klimstra DS, Abedi-Ardekani B, et al. A common classification framework for neuroendocrine neoplasms: an International Agency for Research on Cancer (IARC) and World Health Organization (WHO) expert consensus proposal. 2018;31:1770–1786. https://​doi.​org/​10.​1038/​s41379-018-0110-y.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
Henry A, Nugent A, Wallace IR, et al. Pituitary metastasis: a clinical overview. 2021;90:146–50 (PMID: 34815592).
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
128.
129.
130.
131.
132.
133.
134.
135.
136.
137.
138.
139.
Tillotson CV, Anjum F, Patel BC. Langerhans Cell Histiocytosis. Treasure Island (FL): StatPearls Publishing LLC; 2024.
140.
141.
Brys ADH, Vermeersch S, Forsyth R, et al. Central diabetes insipidus: beware of Langerhans cell histiocytosis! 2018;76:445–449.
142.
143.
144.
Ryan E, J, Ganesh V, Karathanasi A, et al. Langerhans cell histiocytosis with spinal, pulmonary and pituitary involvement: What about ACTH deficiency without diabetes insipidus? A propos of a case. 2020;25:612–7.
145.
146.
147.
148.
149.
150.
151.
Stewart PM, Biller BMK, Marelli C, et al. Exploring Inpatient Hospitalizations and Morbidity in Patients With Adrenal Insufficiency. 2016;101:4843.
152.
153.
Filipsson H, Monson JP, Koltowska-Häggström M, et al. The Impact of Glucocorticoid Replacement Regimens on Metabolic Outcome and Comorbidity in Hypopituitary Patients. 2006;91:3954.
154.
Rahvar A-H, Riesel M, Graf T, Harbeck B. Cardiovascular outcome in patients with adrenal insufficiency—a therapeutic dilemma. 2021;72:582.
155.
Petersons CJ, Mangelsdorf BL, Thompson CH, Burt MG. Acute Effect of Increasing Glucocorticoid Replacement Dose on Cardiovascular Risk and Insulin Sensitivity in Patients With Adrenocorticotrophin Deficiency. 2014;99:2269.
156.
Castinetti F, Sahnoun M, Albarel F, et al. An observational study on adrenal insufficiency in a French tertiary centre: Real life versus theory. 2015;76:1.
157.
Hayashi R, Tamada D, Murata M, et al. Glucocorticoid Replacement Affects Serum Adiponectin Levels and HDL-C in Patients With Secondary Adrenal Insufficiency. 2019;104:5814.
158.
Ragnarsson O, Nyström HF, Johannsson G. Glucocorticoid replacement therapy is independently associated with reduced bone mineral density in women with hypopituitarism. 2012;76:246.
159.
160.
Werumeus Buning J, Van Faassen M, Brummelman P, et al. Effects of Hydrocortisone on the Regulation of Blood Pressure: Results From a Randomized Controlled Trial. 2016;101:3691.
161.
162.
163.
164.
Ragnar Agnarsson H, Johannsson G, Ragnarsson O. The impact of glucocorticoid replacement on bone mineral density in patients with hypopituitarism before and after 2 years of growth hormone replacement therapy. 2014;99:1479.
165.
166.
Al Nofal A, Bancos I, Benkhadra K, Ospina NM, Javed A, Kapoor E, Muthusamy K, Brito JP, Turcu AF, Wang Z, Prokop L, Erickson DZ, Lteif AN, Natt N, Murad MH. Glucocorticoid replacement regimens in chronic adrenal insufficiency: A systematic review and meta-analysis. 2017. https://​doi.​org/​10.​4158/​EP161428.​OR.CrossRef
167.
Zueger T, Kirchner P, Herren C, et al. Glucocorticoid replacement and mortality in patients with nonfunctioning pituitary adenoma. 2015;97:E1938.
168.
Quinkler M, Miodini Nilsen R, Zopf K, et al. Modified-release hydrocortisone decreases BMI and HbA1c in patients with primary and secondary adrenal insufficiency. 2015;172:619.
169.
Isidori AM, Venneri MA, Graziadio C, et al. Effect of once-daily, modified-release hydrocortisone versus standard glucocorticoid therapy on metabolism and innate immunity in patients with adrenal insufficiency (DREAM): a single-blind, randomised controlled trial. 2017;6:173.
170.
Guarnotta V, Ciresi A, Pillitteri G, Giordano C. Improved insulin sensitivity and secretion in prediabetic patients with adrenal insufficiency on dual‐release hydrocortisone treatment: a 36‐month retrospective analysis. 2018;88:665.
171.
Metadata
Title
Effects of glucocorticoid replacement therapy in patients with pituitary disease: A new perspective for personalized replacement therapy
Authors
Sabrina Chiloiro
Alessandra Vicari
Ginevra Mongelli
Flavia Costanza
Antonella Giampietro
Pier Paolo Mattogno
Liverana Lauretti
Alessandro Olivi
Laura De Marinis
Francesco Doglietto
Antonio Bianchi
Alfredo Pontecorvi
Publication date
22-08-2024
Publisher
Springer US
Published in
Reviews in Endocrine and Metabolic Disorders
Print ISSN: 1389-9155
Electronic ISSN: 1573-2606
DOI
https://doi.org/10.1007/s11154-024-09898-6

2024 ESC Congress

Noise pollution dangerous for heart health

Two studies underscore the adverse impact of noise pollution on the risk for and prognosis after myocardial infarction.

Read more

Post-TAVI follow up: deploying virtual assistants

Antihypertensives: more effective at morning or night?

Low Lp(a) levels unlikely to increase the risk of diabetes

» View more highlights on the 2024 ESC Congress hub page

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more
Image Credits