糖皮质激素替代制剂
设计皮质类固醇缓释剂和可变速度的氢化可的松持续输注的目的在于刺激生理性皮质醇分泌的昼夜节律。[35]Isidori AM, Venneri MA, Graziadio C, et al. Effect of once-daily, modified-release hydrocortisone versus standard glucocorticoid therapy on metabolism and innate immunity in patients with adrenal insufficiency (DREAM): a single-blind, randomised controlled trial. Lancet Diabetes Endocrinol. 2018 Mar;6(3):173-85.http://www.ncbi.nlm.nih.gov/pubmed/29229498?tool=bestpractice.com[36]Giordano R, Guaraldi F, Marinazzo E, et al. Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison's disease. Endocrine. 2016 Feb;51(2):360-8.http://www.ncbi.nlm.nih.gov/pubmed/26184416?tool=bestpractice.com[37]Oksnes M, Björnsdottir S, Isaksson M, et al. Continuous subcutaneous hydrocortisone infusion versus oral hydrocortisone replacement for treatment of addison's disease: a randomized clinical trial. J Clin Endocrinol Metab. 2014 May;99(5):1665-74.http://www.ncbi.nlm.nih.gov/pubmed/24517155?tool=bestpractice.com在这些治疗方面的经验尚浅,比起传统治疗,它们在易用性、效率或安全性方面的优势还有待确定。
再生疗法
再生治疗旨在通过在超生理内源性浓度之上使用促肾上腺皮质激素早期治疗来恢复肾上腺功能,或者逆转自身免疫过程。[38]Gan EH, MacArthur K, Mitchell AL, et al. Residual adrenal function in autoimmune Addison's disease: improvement after tetracosactide (ACTH1-24) treatment. J Clin Endocrinol Metab. 2014 Jan;99(1):111-8.https://academic.oup.com/jcem/article/99/1/111/2836213http://www.ncbi.nlm.nih.gov/pubmed/24170102?tool=bestpractice.com[39]Pearce SH, Mitchell AL, Bennett S, et al. Adrenal steroidogenesis after B lymphocyte depletion therapy in new-onset Addison's disease. J Clin Endocrinol Metab. 2012 Oct;97(10):E1927-32.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462934/http://www.ncbi.nlm.nih.gov/pubmed/22767640?tool=bestpractice.com[40]Gan EH, Pearce SH. Management of endocrine disease: regenerative therapies in autoimmune Addison's disease. Eur J Endocrinol. 2017 Mar;176(3):R123-35.https://eje.bioscientifica.com/view/journals/eje/176/3/R123.xmlhttp://www.ncbi.nlm.nih.gov/pubmed/27810905?tool=bestpractice.com虽然从长期来看这些疗法很有前景,但仍处于试验阶段,只能在经批准的研究方案中使用。