Effects of glucocorticoid replacement therapy in patients with pituitary disease: A new perspective for personalized replacement therapy

Sabrina Chiloiro; Alessandra Vicari; Ginevra Mongelli; Flavia Costanza; Antonella Giampietro; Pier Paolo Mattogno; Liverana Lauretti; Alessandro Olivi; Laura De Marinis; Francesco Doglietto; Antonio Bianchi; Alfredo Pontecorvi

doi:10.1007/s11154-024-09898-6

Effects of glucocorticoid replacement therapy in patients with pituitary disease: A new perspective for personalized replacement therapy

Rev Endocr Metab Disord. 2024 Oct;25(5):855-873. doi: 10.1007/s11154-024-09898-6. Epub 2024 Aug 22.

Authors

Sabrina Chiloiro^{1

2}, Alessandra Vicari^{3

4}, Ginevra Mongelli^{1

2}, Flavia Costanza^{1

2}, Antonella Giampietro^{1

2}, Pier Paolo Mattogno^{5

6}, Liverana Lauretti^{5

6}, Alessandro Olivi^{5

6}, Laura De Marinis^{7

8}, Francesco Doglietto^{9

10}, Antonio Bianchi^{1

2}, Alfredo Pontecorvi^{1

2}

Affiliations

¹ Dipartimento di Medicina e Chirurgia traslazionale, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Rome, Italy.
² Pituitary Unit, Department of Endocrinology and Diabetes, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
³ Dipartimento di Medicina e Chirurgia traslazionale, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Rome, Italy. [email protected].
⁴ Pituitary Unit, Department of Endocrinology and Diabetes, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. [email protected].
⁵ Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Department of Ageing, Neurosciences Head Neck, and Orthopedics Sciences, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Rome, Italy.
⁷ Dipartimento di Medicina e Chirurgia traslazionale, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Rome, Italy. [email protected].
⁸ Pituitary Unit, Department of Endocrinology and Diabetes, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. [email protected].
⁹ Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. [email protected].
¹⁰ Department of Ageing, Neurosciences Head Neck, and Orthopedics Sciences, Università Cattolica del Sacro Cuore, Largo A. Gemelli, Rome, Italy. [email protected].

Abstract

Secondary adrenal insufficiency (SAI) is an endocrine disorder due to impaired secretion of ACTH resulting from any disease affecting the pituitary gland. Glucocorticoid replacement therapy is mandatory to ensure patient survival, haemodynamic stability, and quality of life. In fact, a correct dose adjustement is mandatory due to the fact that inappropriately low doses expose patients to hypoadrenal crisis, while inappropriately high doses contribute to glucose metabolic and cardiovascular deterioration. This review analyses the current evidence from available publications on the epidemiology and aetiology of SAI and examines the association between glucocorticoid replacement therapy and glucometabolic and cardiovascular effects.

Keywords: Craniopharyngiomas; Diabetes insipidus; Germinoma; Histiocytosis; Hypophysitis; Hypopituitarism; Metastasis; Pit-NET; Pituitary adenoma; Pituitary neuroendocrine tumors.

Publication types

Review

MeSH terms

Adrenal Insufficiency* / drug therapy
Glucocorticoids* / adverse effects
Glucocorticoids* / therapeutic use
Hormone Replacement Therapy* / methods
Humans
Pituitary Diseases* / drug therapy
Precision Medicine / methods

Substances

Glucocorticoids