ADRENAL INSUFFICIENCY, CORTICOSTEROID TREATMENT, AND ASSOCIATED NEUROLOGICAL DISORDERS: AN EXPLORATION OF PATHOGENIC CONNECTIONS

Abstract

Adrenal insufficiency (AI) is a rare endocrine disorder associated with decreased or absent cortisol production that falls significantly below the threshold required to support physiological homeostasis. There are multiple types of adrenal insufficiency, all of which can be innate (meaning the person was born with AI) or acquired (meaning some external stimulus induced AI), and each has different symptoms based on the exact mechanism of the subtype. Majority of these symptoms are a direct result of low hormone levels and are mitigated by hormone replacement therapy (HRT), usually with oral corticosteroids. Long term oral corticosteroid treatment (hydrocortisone, prednisone, prednisolone, etc) is the gold standard of adrenal insufficiency treatment and has been highly successful in managing disease for thousands of patients, however, recent studies have brought to light the potential dangers of long term exposure to corticosteroids. The aim of this review is to (a) provide background information on the standard function of the HPA axis, genetic causes, and molecular mechanisms of adrenal insufficiency pathogenesis; (b) explore the connections between adrenal insufficiency, long term corticosteroid treatment, and neurological disorders; and finally, (c) provide future direction to establish a more sound understanding of the physiological risks and benefits of long term corticosteroid treatment in individuals with adrenal insufficiency.