Adrenal Insufficiency Therapy: How to Keep the Balance between Good Quality of Life and Low Risk for Long-Term Side Effects?

Glucocorticoid treatment in adrenal insufficiency remains a challenge since many patients complain of fatigue, reduced health-related quality of life and working ability. Moreover, there is a fear of increased mortality and morbidity related to adrenal crises and chronic overexposure to glucocorticoids. In order to counter these negative effects on daily life and future health, recent recommendations speak for lower replacement doses and administration forms that attempt to mimic the circadian variation in cortisol. At the same time, low replacement doses should not put the patient at an increased risk of an adrenal crisis. This chapter provides an overview of current state-of-the-art approaches to treatment and follow-up of adrenal insufficiency aimed at avoiding over- and undertreatment.