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Journal of Endocrinological Investigation
Published in: Journal of Endocrinological Investigation 5/2020

01-05-2020 | Glucocorticoid | Consensus Statement

Towards the tailoring of glucocorticoid replacement in adrenal insufficiency: the Italian Society of Endocrinology Expert Opinion

Authors: A. M. Isidori, G. Arnaldi, M. Boscaro, A. Falorni, C. Giordano, R. Giordano, R. Pivonello, C. Pozza, E. Sbardella, C. Simeoli, C. Scaroni, A. Lenzi, On behalf of the Italian Society of Endocrinology

Published in: Journal of Endocrinological Investigation | Issue 5/2020

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Abstract

Context

Glucocorticoid (GC) replacement therapy in patients with adrenal insufficiency (AI) is life saving. After over 50 years of conventional GC treatment, novel formulations are now entering routine clinical practice.

Methods

Given the spectrum of medications currently available and new insights into the understanding of AI, the authors reviewed relevant medical literature with emphasis on original studies, prospective observational data and randomized controlled trials performed in the past 35 years. The Expert Opinion of a panel of selected endocrinologists was sought to answer specific clinical questions. The objective was to provide an evidence-supported guide, for the use of GC in various settings from university hospitals to outpatient clinics, that offers specific advice tailored to the individual patient.

Results

The Panel reviewed available GC replacement therapies, comprising short-acting, intermediate and long-acting oral formulations, subcutaneous formulations and the novel modified-release hydrocortisone. Advantages and disadvantages of these formulations were reviewed.

Conclusions

In the Panel’s opinion, achieving the optimal GC timing and dosing is needed to improve the outcome of AI. No-single formulation offers the best option for every patients. Recent data suggest that more emphasis should be given to the timing of intake. Tailoring of GS should be attempted in all patients—by experts—on a case-by-case basis. The Panel identified specific subgroups of AI patients that could be help by this process. Long-term studies are needed to confirm the short-term benefits associated with the modified-release GCs. The impact of GC tailoring has yet to be proven in terms of hospitalization rate, morbidity and mortality.
Appendix
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Metadata
Title
Towards the tailoring of glucocorticoid replacement in adrenal insufficiency: the Italian Society of Endocrinology Expert Opinion
Authors
A. M. Isidori
G. Arnaldi
M. Boscaro
A. Falorni
C. Giordano
R. Giordano
R. Pivonello
C. Pozza
E. Sbardella
C. Simeoli
C. Scaroni
A. Lenzi
On behalf of the Italian Society of Endocrinology
Publication date
01-05-2020
Publisher
Springer International Publishing
Published in
Journal of Endocrinological Investigation / Issue 5/2020
Electronic ISSN: 1720-8386
DOI
https://doi.org/10.1007/s40618-019-01146-y

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Keynote webinar | Spotlight on medication adherence

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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