Nebenniereninsuffizienz

 

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Zusammenfassung

Trotz etablierter Substitutionstherapie geht die chronische Nebenniereninsuffizienz oftmals einher mit einer eingeschränkten subjektiven Lebensqualität (u. a. assoziiert mit einer höheren Zahl an Fehltagen am Arbeitsplatz sowie geringerer Berufstätigkeit) und einer erhöhten Mortalität. Bei individualisierter Dosiseinstellung mit Vermeidung einer Übersubstitution ist nicht von einer relevanten Nebenwirkungsrate der Glukokortikoid-Therapie auszugehen. Neben der Standardtherapie mit Hydrocortison wurden kürzlich neue Formulierungen und Verabreichungsarten in klinischen Studien evaluiert, durch die die physiologische Cortisol-Tagesrhythmik bestmöglich nachgeahmt werden soll. Nebennierenkrisen sind eine potenzielle Bedrohung für Patienten auch unter etablierter Hormonersatztherapie. Hauptauslöser sind Infekte. Als weitere Risikofaktoren konnten das Vorliegen einer primären Nebenniereninsuffizienz, Komorbiditäten und vorhergehende Nebennierenkrisen detektiert werden. Um u. a. das Notfallmanagement zu verbessern, wird derzeit deutschlandweit ein standardisiertes Schulungsprogramm für Patienten etabliert. Erste Analysen zeigen eine anhaltende Verbesserung des Schulungsstatus und des subjektiven Sicherheitsempfindens der Patienten.

Abstract

Even under established replacement therapy, chronic adrenal insufficiency is associated with an impairment in daily life activities and a higher number of sick-days. In patients with individually adjusted glucocorticoid doses (avoiding over-replacement) the frequency of glucocorticoid side effects is low. Besides the standard treatment with conventional hydrocortisone, new formulas aiming at more adjusted physiological circadian cortisol profiles or improved individual dosing have been evaluated in recent clinical trials. Adrenal crisis is a potential threat for patients with chronic adrenal insufficiency even under established hormone replacement therapy, which is triggered by infectious diseases mostly. Primary adrenal insufficiency, comorbidities and previous adrenal crisis were identified as risk factors. To improve the emergency-management in patients with adrenal insufficiency a nation-wide standardized education program for patients and relatives has been established in Germany. First results show an ongoing improvement of handling their sickness and certitude in patients with chronic adrenal insufficiency.

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