MANAGEMENT OF ENDOCRINE DISEASE: Risk of overtreatment in patients with adrenal insufficiency: current and emerging aspects

Eur J Endocrinol. 2017 Nov;177(5):R231-R248. doi: 10.1530/EJE-17-0154. Epub 2017 Jun 5.


The effects of long-term replacement therapy of adrenal insufficiency (AI) are still a matter of controversy. In fact, the established glucocorticoid replacement regimens do not completely reproduce the endogenous hormonal production and the monitoring of AI treatment may be a challenge for the lack of reliable clinical and biochemical markers. Consequently, several AI patients are frequently exposed to relative glucocorticoid excess potentially leading to develop chronic complications, such as diabetes mellitus, dyslipidemia, hypertension and fragility fractures with consequent impaired QoL and increased mortality risk. This review deals with the pathophysiological and clinical aspects concerning the over-replacement therapy of primary and secondary AI.

Publication types

  • Review

MeSH terms

  • Adrenal Insufficiency / blood
  • Adrenal Insufficiency / diagnosis*
  • Adrenal Insufficiency / therapy*
  • Disease Management*
  • Hormone Replacement Therapy / adverse effects
  • Hormone Replacement Therapy / methods
  • Humans
  • Hydrocortisone / therapeutic use
  • Medical Overuse / prevention & control*
  • Risk Factors


  • Hydrocortisone