Glucocorticoid deficiency is the clinical state characterised by inadequate cortisol production. It may occur due to the primary failure of the adrenal cortex or to lack of stimulation of the adrenal cortex by adrenocorticotropic hormone. The aim of treatment of glucocorticoid deficiency is to mimic the normal physiological secretion of cortisol, in order to normalise quality of life and reverse pathological sequelae. However, the diurnal rhythm of cortisol secretion is difficult to reproduce with exogenous glucocorticoid therapy. There is wide inter- and intra-individual variability of in the dynamics of physiological glucocorticoid secretion, and glucocorticoid preparations that are currently available cannot reproduce physiological profiles. In addition, there are no reliable biomarkers to determine the adequacy of treatment. The treatment of acute glucocorticoid deficiency/ adrenal crisis involves prompt recognition and administration of parenteral hydrocortisone, rehydration, and management of electrolyte abnormalities. In the management of chronic glucocorticoid deficiency, the prevention of adrenal crisis must be balanced with avoidance of the long-term adverse effects of over-replacement. This requires close collaboration with the patient, for whom education and empowerment in the management of glucocorticoid deficiency, and the prevention of crises, are crucial.

中文翻译：

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糖皮质激素缺乏症的治疗：当前和未来的观点。

糖皮质激素缺乏症是以皮质醇产生不足为特征的临床状态。它可能是由于肾上腺皮质的主要衰竭或肾上腺皮质激素对肾上腺皮质缺乏刺激而发生的。治疗糖皮质激素缺乏症的目的是模仿皮质醇的正常生理分泌，以使生活质量正常化并逆转病理后遗症。然而，外源性糖皮质激素治疗难以再现皮质醇分泌的昼夜节律。生理性糖皮质激素分泌动力学的个体间和个体内差异很大，目前可用的糖皮质激素制剂不能复制生理特征。另外，没有可靠的生物标志物来确定治疗的适当性。急性糖皮质激素缺乏/肾上腺危机的治疗涉及迅速识别和给予肠胃外氢化可的松，补液和管理电解质异常。在慢性糖皮质激素缺乏症的治疗中，必须在避免肾上腺皮质激素危机与避免过度替代的长期不良影响之间取得平衡。这需要与患者密切合作，对于患者而言，在糖皮质激素缺乏症的治疗和预防危机方面的教育和授权至关重要。预防肾上腺危机必须与避免过度替代的长期不利影响保持平衡。这需要与患者密切合作，对于患者而言，在糖皮质激素缺乏症的治疗和预防危机方面的教育和授权至关重要。预防肾上腺危机必须与避免过度替代的长期不利影响保持平衡。这需要与患者密切合作，对于患者而言，在糖皮质激素缺乏症的治疗和预防危机方面的教育和授权至关重要。