Adrenal insufficiency treated with conventional hydrocortisone leads to elevated levels of Interleukin-6: a pilot study

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...