III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Medizinisches Versorgungszentrum (MVZ) Amedes Experts, Endocrinology, Hamburg, Germany.
Front Endocrinol (Lausanne). 2023 Mar 17;14:1153595. doi: 10.3389/fendo.2023.1153595. eCollection 2023.
Patients with adrenal insufficiency (AI) are treated with conventional or modified-release glucocorticoid (GC) replacement therapy (GRT). Although current GRT regimens aim to mimic the physiological circadian pattern of cortisol secretion, temporary phases of hypo- and hypercortisolism are common. There is good evidence that prolonged phases of hypo- or hypercortisolism are associated with impaired cognitive functioning. However, little is known about cognitive functioning in patients with AI regarding the effects of dosage and duration of glucocorticoid replacement therapy. There is also little data available comparing the effects of GC therapy on patients with primary and secondary forms of AI as well as with respect to different formulas. This Mini-Review gives an overview of the current studies on GRT for primary and secondary AI and their impact on cognition. Strengths and weaknesses of the studies and their Implications for clinical daily routine are discussed with a special emphasis on practical considerations for the treating endocrinologist.
患有肾上腺功能不全（AI）的患者接受常规或改良释放糖皮质激素（GC）替代治疗（GRT）。尽管目前的 GRT 方案旨在模拟皮质醇分泌的生理昼夜节律模式，但短暂的低皮质醇和高皮质醇状态很常见。有充分的证据表明，长时间的低皮质醇或高皮质醇状态与认知功能受损有关。然而，对于 AI 患者，关于糖皮质激素替代治疗的剂量和持续时间对认知功能的影响知之甚少。关于原发性和继发性 AI 患者以及不同配方的 GC 治疗效果的比较数据也很少。这篇迷你综述概述了原发性和继发性 AI 的 GRT 研究及其对认知的影响。讨论了研究的优缺点及其对临床日常实践的影响，并特别强调了治疗内分泌学家的实际考虑因素。
