*This Research Topic is a continuation of "
Adrenal Insufficiency: Diagnostic Approaches, Treatments, and Outcomes"*
Adrenal Insufficiency is a life-threatening condition characterized by inadequate glucocorticoid production as a result of adrenal cortex destruction (primary adrenal insufficiency) or inadequate Adrenocorticotropic Hormone (ACTH) stimulation (secondary and tertiary adrenal insufficiency.) In primary adrenal insufficiency (PAI) lack of mineralocorticoids is also a feature.
Regardless of the etiology, adrenal insufficiency remains a diagnostic and therapeutic challenge. Adrenal insufficiency may be underrecognized and symptoms of adrenal crisis misdiagnosed, leading to increased morbidity and mortality. Chronic management of this condition revolves around steroid replacement therapy, attempting to mimic the diurnal rhythm of cortisol production. Inability of current steroid regimes to replicate physiology results in steroid over-replacement can increase cardiovascular risk and potentially contributes to the increased mortality and reduced quality of life observed in these patients.
Incidence of infections, infection-related hospitalization and infection- related mortality are higher in patients with adrenal insufficiency. Modified-release glucocorticoid preparations and continuous subcutaneous hydrocortisone infusion result in more physiological cortisol levels and may offer clinical benefits. Patient education on steroid dose adjustment is a key management feature, impacting on prevention of adrenal crises and quality of life. Recent evidence suggests novel management schedules to: individualize treatment, address several unmet needs, and improve therapeutic outcomes in selected subgroups of patients with adrenal insufficiency.
The aim of this issue is to provide a comprehensive review of the most recent findings on clinical presentation, pathophysiology, diagnosis, and therapeutic choices and outcomes in patients with adrenal insufficiency. We welcome research on, but not limited to, the following:
We welcome manuscripts such as original research, reviews, perspectives, on the following topics.
- Epidemiology of adrenal insufficiency and adrenal crises;
- Diagnostic advances and challenges of adrenal insufficiency, in particular the use of newer monoclonal immunoassays and liquid chromatography tandem mass spectrometry assays;
- Challenging clinical cases of adrenal insufficiency;
- Advances in management of adrenal insufficiency, including modified release glucocorticoid preparations, continuous subcutaneous hydrocortisone infusion, and immunomodulatory therapies in autoimmune primary adrenal insufficiency;
- Physician and patient education programs and interventions and the effect on patient outcomes;
- Epidemiology of COVID-19 infection, risk of hospitalization and adrenal crisis in patients with adrenal insufficiency.