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Glucocorticoid replacement in Addison disease

Nature Reviews Endocrinology volume 14, page 562 (2018)Cite this article

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In a recent News & Views by Lisa Muller and Marcus Quinkler (Imitating the cortisol profile improves the immune system. Nat. Rev. Endocrinol. 14, 137–139 (2018))1, the authors suggest that optimum glucocorticoid replacement for the treatment of Addison disease is once-daily modified-release hydrocortisone (MR-hydrocortisone), instead of thrice-daily standard hydrocortisone. Standard hydrocortisone is administered thrice-daily because it has a short half-life. Prednisolone2, however, offers a cheaper once-daily replacement for the treatment of Addison disease, costing £43 per annum in the United Kingdom compared with £2,900 for MR-hydrocortisone. To date, randomized controlled trials comparing outcomes from different glucocorticoid replacement regimens in patients with adrenal failure have only been carried out with MR-hydrocortisone. The utility of cheaper drugs like prednisolone is unknown because of a reluctance to conduct expensive randomized controlled trials to test them.

For patients with Addison disease, the dose of glucocorticoid and the timing of treatment are crucial for achieving a satisfactory quality of life. If a patient does not receive a high enough dose of glucocorticoid at the right time, they are at increased risk of morbidity and mortality resulting from an Addisonian crisis. In the past, most clinicians have erred on the side of excess replacement to avoid such a crisis3,4,5 but the association of high doses of glucocorticoid with cardiovascular mortality is concerning.

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Authors and Affiliations

  1. Metabolic Medicine, Charing Cross Hospital, London, UK

    Sirazum Choudhury

  2. Imperial College, Endocrinology and Diabetes, Charing Cross Hospital, London, UK

    Karim Meeran

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  1. Sirazum Choudhury
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  2. Karim Meeran
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Correspondence to Karim Meeran.

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Choudhury, S., Meeran, K. Glucocorticoid replacement in Addison disease. Nat Rev Endocrinol 14, 562 (2018). https://doi.org/10.1038/s41574-018-0049-6

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