Cardiovascular disease (CVD) is themost common cause of death in the world. Recent studies have shown an association between\nadrenal insufficiency (AI) and increased cardiovascular risk (CVR). Patients with AI receive glucocorticoid (GC) replacement\ntherapy which can lead to varying levels of blood cortisol. It was shown that these imbalances in blood cortisol may lead to a higher\nprevalence of coronary heart disease, major adverse coronary events, and increased mortality. GC substitution is essential in the\ntreatment ofAIwithoutwhich the disease has been shown to be fatal.Themost frequently usedGC formula for replacement therapy\nis hydrocortisone (HC). There is no uniformopinion on hydrocortisone replacement therapy. Alternative GC such as prednisolone\nis also in use. Overreplacement of GC may lead to adverse effects including obesity, high blood pressure, and hyperglycaemia.\nOutcome may vary between primary and secondary AI mainly due to differences in the renin-angiotensin-aldosterone system\n(RAAS). Furthermore, decreased blood levels of cortisol may lead to a compensatory secretion of inflammatory mediators such as\nInterleukin-1 (IL-1), Interleukin-6 (IL-6), and/or tumor-necrosis factor (TNF). Physicians and patients should be properly educated\nabout the increased risk of CVD in patients with AI.
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