Table_1_Glucocorticoid replacement therapy for primary and secondary adrenal insufficiency and their impact on cognition.docx

Patients with adrenal insufficiency (AI) are treated with conventional or modified-release glucocorticoid (GC) replacement therapy (GRT). Although current GRT regimens aim to mimic the physiological circadian pattern of cortisol secretion, temporary phases of hypo- and hypercortisolism are common. There is good evidence that prolonged phases of hypo- or hypercortisolism are associated with impaired cognitive functioning. However, little is known about cognitive functioning in patients with AI regarding the effects of dosage and duration of glucocorticoid replacement therapy. There is also little data available comparing the effects of GC therapy on patients with primary and secondary forms of AI as well as with respect to different formulas. This Mini-Review gives an overview of the current studies on GRT for primary and secondary AI and their impact on cognition. Strengths and weaknesses of the studies and their Implications for clinical daily routine are discussed with a special emphasis on practical considerations for the treating endocrinologist.

肾上腺功能不全（AI）患者需接受常规或缓释型糖皮质激素（GC）替代治疗（GRT）。尽管当前GRT方案旨在模拟皮质醇分泌的生理性昼夜节律模式，但皮质醇减退与亢进的暂时性阶段仍较为常见。现有充分证据表明，长期皮质醇减退或亢进状态与认知功能受损密切相关。然而，目前关于AI患者认知功能受糖皮质激素替代治疗剂量与疗程影响的相关研究仍较为匮乏，且针对原发性与继发性AI患者的GC治疗效果对比、以及不同糖皮质激素制剂间疗效差异的相关数据亦十分有限。本迷你综述概述了当前针对原发性与继发性AI的GRT相关研究及其对认知功能的影响，并探讨了现有研究的优势与局限性，以及其对临床日常诊疗的指导意义，重点关注了临床内分泌科医师诊疗实践中的实际考量要点。