Table 1.

Different therapeutic approaches in glucocorticoid replacement therapy: formulations and usage aspects

	Different therapeutic approaches in glucocorticoid replacement therapy
	Short acting glucocorticoids [6, 29]		Sustained-release glucocorticoids		Long-acting glucocorticoids		Continuous subcutaneous hydrocortisone
	Hydrocortisone	Cortisone acetate	Plenadren®	Chronocort®	Prednisone	Dexamethasone
Positive aspects	• safety, • low cost		• Mimics physiological secretion rate more accurately [30, 31], • benefits on immune system, • reduced risk of osteopenia/osteoporosis [32], • benefits on lipid and glucose metabolism [33]	• benefits on immune system, • reduced risk of osteopenia/osteoporosis [32], • benefits on lipid and glucose metabolism[33], • better mimics the circadian pattern [35] • mimics nocturnal cortisol rise [7]	• more useful in primary adrenal insufficiency and congenital adrenal hyperplasia		• Mimic physiological secretion rate [39, 40]
Negative aspects	• No reproduction of physiological secretion rate		• not always effective on fatigue [34], • does not mimic nocturnal cortisol rise [35], • no reproduction of pulsatile secretion pattern [36]	• no reproduction of pulsatile secretion pattern [36]	• No reproduction of physiological secretion rate, • no recovery of spontaneous ACTH secretion [2]		• discomfort [37]