LAUSR

Adrenal insufficiency is a rare disease with an estimated prevalence of 100–126 cases per million for primary adrenal insufficiency (PAI) and 450 cases per million for secondary/tertiary adrenal insufficiency (SAI/TAI) [1, 2]. Glucocorticoid replacement therapy (GRT) is the gold standard and only viable treatment for AI [3]. The present guideline on PAI recommends the use of hydrocortisone (HC) or prednisolone for GRT [3]. However, currently used GRT regimens inadequately mimic the physiological rhythm of endogenous cortisol secretion leading to temporary hypercortisolism and hypocortisolism [4]. The consequences of these conditions are not completely understood but may be associated with deleterious effects on body composition [5]. In fact, patients with AI on GRT have an increased cardiovascular and cerebrovascular mortality [6, 7]. Since inflammation is known to have a role in the pathogenesis of cardiovascular diseases, measurement of inflammatory markers has been suggested for risk assessment. Atherosclerosis is a chronic inflammatory disease with IL-6 as a main player in the vascular inflammatory cascade. Only few data are available about IL-6 in patients receiving GRT. Previous studies have shown an increased secretion of IL-6 and to a lesser extent of TNF-α and IL-1 in patients with hypocortisolism [8–10]. Higher serum levels of IL-6 may lead to increased cardiovascular risk (CVR) and overall mortality from cardiovascular disease [11, 12]. Aim of this pilot study was to evaluate inflammatory markers in AI patients treated with conventional HC replacement therapy. In particular, elevation of IL-6 and the time of increase were assessed in a clinical setting. Material and methods