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Substitution mit Nebennierensteroiden

Replacement therapy with adrenal steroids

  • Schwerpunkt: Hormontherapie
  • Published:
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Zusammenfassung

Die Substitution mit Nebennierensteroiden umfasst den Ersatz von Glukokortikoiden, Mineralokortikoiden und adrenalen Androgenvorläufern (DHEA). Die primäre Indikation besteht bei Patienten mit nachgewiesener Nebennierenrindeninsuffizienz. Durch die aktuelle Substitutionstherapie lässt sich bei diesen Patienten meist jedoch keine vollständige Wiederherstellung von Leistungsfähigkeit und Wohlbefinden erreichen. Daher wurden Glukokortikoidpräparate entwickelt, die dem physiologischen Cortisolprofil näher kommen als bisherige Präparate und damit möglicherweise eine Verbesserung in der Substitutionsbehandlung bewirken. Weitere Aufmerksamkeit hat eine Substitutionstherapie mit adrenalen Steroiden im Zusammenhang mit dem Konzept der relativen Nebenniereninsuffizienz bei Sepsis erfahren. Der Einsatz von Glukokortikoiden in der Behandlung von Patienten mit septischem Schock ist nach den Ergebnissen der CORTICUS-Studie allerdings wieder deutlich eingeschränkt worden. Durch eine Substitutionsbehandlung mit dem adrenalen Androgenvorläufer Dehydroepiandrosteron (DHEA) lässt sich bei Patienten mit Nebennierenrindeninsuffizienz oft eine Verbesserung des subjektiven Wohlbefindens und der Libido erreichen. Der Einsatz von DHEA als Anti-Aging-Präparat bei Personen mit altersbedingter Abnahme der DHEA-Sekretion ist anhand der vorliegenden Evidenz nicht gerechtfertigt.

Abstract

Replacement with adrenal steroids comprises treatment with glucocorticoids, mineralocorticoids and adrenal androgen precursors, mainly in patients with adrenal insufficiency. Attention has also been directed to replacement treatment with glucocorticoids in critically ill patients or with dehydroepiandrosterone (DHEA) in elderly people with an age related decline of DHEA/DHEAS levels. Despite the use of current replacement concepts well-being is often not fully restored in patients with adrenal insufficiency. Innovations comprise the development of new delayed release glucocorticoid preparations that allow to better mimic the circadian cortisol secretion and may have the potential to improve the treatment of patients with adrenal insufficiency. Recent results from the CORTICUS study have not confirmed previous beneficial results and have led to restrictions in the use of hydrocortisone substitution therapy in patients with septic shock. Treatment with the androgen precursor DHEA in patients with adrenal insufficiency may improve quality of life. However, in patients with an age related decline of DHEA levels, the available evidence does not support the use of DHEA replacement as an anti aging treatment.

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  1. Schwerpunkt Endokrinologie und Diabetologie, Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Deutschland

    S. Hahner & B. Allolio

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  1. S. Hahner
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  2. B. Allolio
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Correspondence to S. Hahner.

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Hahner, S., Allolio, B. Substitution mit Nebennierensteroiden. Internist 49, 545–552 (2008). https://doi.org/10.1007/s00108-008-2122-z

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