Arguments in favor of hormonal substitution with longer half live glucocorticoids in the adrenal failure

The substitution treatment of adrenal failure is, in our country, made with hydrocortisone, sometimes completed by 9α fludrocortisone. Nevertheless, the profiles of serum cortisol are too fluctuating with such regimen resulting in coexisting signs and symptoms of deficit and excess of corticoids. Moreover, such variations trigger excessive hypothalamic- pituitary hormonal secretion, responsible for melanodermia and pituitary hyperplasia or adenoma and there are no biological criteria sensitive enough for an optimal hormonal substitution therapy. According to literature data and nine personal cases, we provide some arguments in favor of hormonal substitution treatment of adrenal failure with longer half life glucocorticoids.