Современные возможности и перспективы в терапии надпочечниковой недостаточности

Надпочечниковая недостаточность (НН) — опасное для жизни заболевание, характеризующееся снижением выработки гормонов корой надпочечников и требующее пожизненной заместительной терапии глюкокортикоидами (ГК), а в некоторых случаях и минералокортикоидами (МК). Число лиц с первичной и вторичной НН в Европе оценивается в 20-50 на 100 тыс. человек, рост числа случаев данного заболевания в мире может быть частично связан со стремительным увеличением частоты использования ГК в различных клинических стратегиях, в т.ч. при онкологических заболеваниях.

При НН жизненно важной является заместительная гормональная терапия, однако использование ГК в долгосрочной перспективе может быть связано с различными нежелательными эффектами, особенно при применении нефизиологических концентраций ГК. В данном обзоре представлен краткий обзор актуальных терапевтических возможностей гормональной терапии НН, способствующей профилактике развития надпочечниковых кризов, а также перспективных возможностей более эффективной имитации физиологического профиля кортизола, направленных на профилактику развития нежелательных эффектов терапии. В настоящее время доступно несколько различных форм ГК, различающихся по профилю, длительности действия и способу введения. Наиболее предпочтительными в настоящее время в лечении НН являются ГК с коротким периодом полувыведения, что обеспечивает более управляемый профиль действия и меньший риск побочных эффектов. К перспективным возможностям заместительной терапии относят препараты гидрокортизона модифицированного высвобождения, а также новые методы введения препарата с применением инсулиновой помпы, что позволит лучше имитировать физиологическое действие эндогенного кортизола.

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