Replacement Therapies in Adrenal Insufficiency

Peter Hindmarsh is a Professor of Pediatric Endocrinology in London, United Kingdom. He has published extensively on cortisol physiology and pharmacology and how these impact on replacement therapies for adrenal insufficiency. He is interested in better delivery of treatment in a more physiological manner as exemplified by the delivery of hydrocortisone using pump therapy to mimic the circadian rhythm.As the parent of a young adult with Salt Wasting Congenital Adrenal Hyperplasia, Kathy Geertsma became chair of a Congenital Adrenal Hyperplasia Patient, Parent and Carer Information and Support Group known as CAHISUS. She has extensive contact with patients, parents, and carers from all over the world who struggle with confirming the cause for adrenal insufficiency and getting access to proper treatment. As a result, she offers a unique perspective about how practitioners can better serve the needs of their patients.

• 1. Why do we need to get hydrocortisone replacement right?2. Mortality and morbidity data3. Side effects and survey results of quality of life4. Oral Glucocorticoid replacement5. What is dosing regimen6. How to calculate daily dose7. How to distribute the dose8. Drug interactions including drugs that alter liver metabolism9. Specific problems with hormone replacement – oral or transdermal estrogens10. Interplay of cortisol and vasopressin – diagnosis of diabetes insipidus and DDAVP replacement11. Pituitary replacement that may modify hydrocortisone dosing – thyroxine and growth hormone12. Monitoring replacement13. What’s missing what are we replacing what should we check14. Ways of checking 17OHP, ACTH cortisol15. Single sample versus multiple samples16. Around dose sampling17. Effects of OCP18. Adjusting doses for events19. Illness and the boxes20. Stressful events21. Surgery22. Dental and the boxes23. Travel and time zones24. Adjustments and effects on other hormones e.g. DDAVP25. Glucocorticoid replacement using pump therapy26. Pump therapy to mimic circadian rhythm27. Principles of the pump28. Setting the system up, clearance studies29. Monitoring replacement30. Quality of life31. Managing an Adrenal Crisis32. Presentation as new diagnosis or following diagnosis33. What it is and what it is not34. Biochemical changes35. How to manage a crisis - at home, in A&E after admission36. Hydrocortisone requirements in a crisis37. Glucose requirements during a crisis38. Sodium and fluid balance - the importance of subacute or chronic hyponatraemia39. Hyperkalaemia40. Weaning Glucocorticoids41. Factors influencing adrenal suppression dose, type of steroid, how long given, potency and whether given during day or night42. The role of alternate day treatments43. Principles in weaning44. How to wean depending on duration of exposure, disease activity steroid used45. What tests to use to determine axis recovery