Multiple benefits from dual release hydrocortisone: a “hard” view from bones

Excerpt

More than 160 years have passed since the description of primary adrenal insufficiency (PAI) by Thomas Addison in 1849 [1] and the only milestone in its management has been the discovery of hydrocortisone. For nearly a century, adrenal insufficiency (AI) was a lethal disease [2]. Hydrocortisone changed the landscape and transformed both PAI and secondary AI (SAI) to a chronic condition [2, 3]. The fortunate prolongation of survival soon led to the recognition of shortcomings related to hydrocortisone therapy; on the one hand, inadequate replacement, especially during periods of stress, results in life-threatening adrenal crises and, on the other, over-replacement is associated with the adverse effects of hypercortisolism [4, 5]. As a consequence patients with AI experience poor quality of life, as well as morbidity and mortality rates exceeding those of the general population [4]. …