Glucocorticoid replacement therapies: past, present and future. (October 2019)

• Record Type: Journal Article
• Authors: Liew, Su-Yi; Akker, Scott A.; Guasti, Leonardo; Pittaway, James F.H.
• Is Part Of: Current opinion in endocrine and metabolic research. Volume 8(2019)
• Page Start: 152
• Page End: 159
• Publication Date: 2019-10
• Subjects: Glucocorticoid -- Adrenal insufficiency -- Stem cell -- Regenerative medicine; GC glucocorticoid -- PAI primary adrenal insufficiency -- SAI secondary adrenal insufficiency -- HPA hypothalamic–pituitary–adrenal -- ACTH adrenocorticotropic hormone -- CRH corticotropin-releasing hormone -- DHEA dehydroepiandrosterone -- CSHI continuous subcutaneous hydrocortisone infusion -- APECED autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy -- PKA protein kinase A -- LHRH luteinising hormone–releasing hormone; Endocrine glands -- Diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; Endocrine System Diseases; Metabolic Diseases; Endocrine glands -- Diseases; Metabolism -- Disorders; Periodical; Electronic journals; Periodicals; Electronic journals; 616.4
• DOI: 10.1016/j.coemr.2019.08.011
• Languages: English
• ISSNs: 2451-9650

Abstract

Abstract: Since the original description of adrenal insufficiency by Thomas Addison in 1855, there has been an exponential growth in the understanding of adrenal gland biology and its role in the hypothalamic–pituitary–adrenal axis. Despite this, the mainstay of therapeutic glucocorticoid replacement for most clinicians has remained unchanged for nearly 50 years. More recently, there has been better recognition of the morbidity and mortality associated with current approaches and the challenges to tackle in reducing this and improving clinical outcomes. In this review, we have summarised the history of glucocorticoid replacement therapy from its nascence in the 1930s, through common practice and culminating in more recent glucocorticoid replacement strategies plus the potential of stem cell therapy in the future. Graphical abstract: Image 1 Highlights: Adrenal insufficiency was first described by the English physician Thomas Addison in 1855. One hundred per cent (or 100%) mortality was observed until the discovery and synthesis of adrenocortical hormones in 1930s. Since 1970, treatment options have changed little, but associated morbidity is better defined. Novel preparations of glucocorticoid replacement aim to more closely mimic innate physiology. Adrenocortical cells, regenerated from differentiated cells, provide hope for future therapy.