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L’Endocrinologo

, Volume 12, Issue 6, pp 288–296 | Cite as

Terapia sostitutiva dell’insufficienza surrenalica: quali novità

  • Alberto Falorni
  • Viviana Minarelli
  • Emilia Sbroma Tomaro
Article
  • 68 Downloads

Riassunto

L’insufficienza corticosurrenalica è causata dalla distruzione o alterata funzione delle cellule della corteccia surrenalica per una patologia primitiva del surrene (più spesso autoimmunitaria) o ipotalamo-ipofisaria, per il deficit di ACTH. Il quadro clinico è determinato dal deficit di glucocorticoidi e talora di mineralcorticoidi ed androgeni surrenalici. La terapia sostitutiva è finalizzata a ridurre i segni e sintomi clinici della patologia e a prevenire lo sviluppo della crisi addisoniana, una emergenza clinica caratterizzata da shock ipovolemico. Il trattamento orale con idrocortisone o cortisone acetato deve tendere a mimare il normale profilo circadiano del rilascio di cortisolo, utilizzando le dosi minimi possibili che garantiscano una adeguata qualità della vita dei pazienti. Gli attuali preparati di idrocortisone e cortisone acetato non permettono di riprodurre fedelmente il fisiologico pattern secretivo del cortisolo, sia in termini qualitativi che quantitativi. Nuovi preparati di idrocortisone a rilascio modificato, attualmente in fase di pre-registrazione per uso clinico, rappresentano interessanti alternative alla terapia sostitutiva classica, al fine di ottimizzare il trattamento dell’insufficienza corticosurrenalica e ridurre gli effetti dannosi di un’esposizione non fisiologica ai glucocorticoidi a livello sistemico e tissutale, nonché di un alterato ritmo circadiano del profilo del cortisolo plasmatico.

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Copyright information

© Springer International Publishing AG 2011

Authors and Affiliations

  • Alberto Falorni
    • 1
  • Viviana Minarelli
    • 1
  • Emilia Sbroma Tomaro
    • 1
  1. 1.Dipartimento di Medicina Interna, Sezione di Medicina Interna e Scienze Endocrine e MetabolicheUniversità di PerugiaPerugiaItalia

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