Poor outcomes for patients with adrenal insufficiency – Hadden Lecture

A traditional highlight of the Irish Endocrine Society Annual Meeting is the Hadden Lecture. This year’s lecture was on the subject of adrenal insufficiency. It was delivered by Prof Gudmundur Johannsson, University of Gothenburg, Sweden.

The title of the lecture was ‘Disease burden and novel treatments in adrenal insufficiency’.

In the lecture, Prof Johannsson highlighted recent data showing relatively poor outcomes for patients with adrenal insufficiency.

The condition occurs when the adrenal glands do not produce sufficient quantities of cortisol.

Speaking to the Medical Independent (MI) prior to his lecture, Prof Johannsson pointed out how patients with type 1 diabetes (T1D) receive care “in a much more sophisticated and structured way” than patients with adrenal inefficiency.

Prof Johannsson said a reason why outcomes for patients are suboptimal is due to the challenges in administering glucocorticoid replacement therapy.

The cornerstone of the therapy is oral hydrocortisone, taken in divided doses.

“The way we manage patients’ glucocorticoid replacement is not sufficient or adequate,” Prof Johannsson told MI.

“And the reason is cortisol is one of the few hormones that has a very large diurnal variation – it is much higher during the morning and much lower during the night…. It is difficult to manage treatment in a way that mimics the normal physiology.”

He said attempts to improve the methods by which the treatment is administered have fallen significantly short of the progress achieved in how insulin is delivered for people with T1D.

“There are ongoing attempts to do something similar for patients with adrenal insufficiency,” he said.

“Having pumps and other more sophisticated devices to deliver cortisol in a more physiological way. There are things happening, but we are approximately 20 or 30 years behind.”

While there are patients who benefit from current treatment options, “there is another group who do less well or quite bad on what we offer them.”

On the positive side, he stated some recent products have been developed “that could be of benefit to the patients”.

Also, there is currently no biomarker that can quantify the action of glucocorticoids.

Prof Johannsson and his research team have been attempting to identify biomarkers in relation to the condition.

He was involved in a 2021 study entitled ‘Identification of human glucocorticoid response markers using integrated multi-omic analysis from a randomised crossover trial’.

The study revealed networks of genes, metabolites, and microRNAs that are associated with glucocorticoid activity. One microRNA (miR-122-5p) stood out as a potential way to measure this activity.

Prof Johannsson said such research is “only the very tiny first step in identifying something that is clinically useful”.