ESPE Yearbook of Paediatric Endocrinology

J Intern Med. 2024;296(2):121-138. PMID: 38825772 doi: 10.1111/joim.13795. https://pubmed.ncbi.nlm.nih.gov/38825772/

Brief summary: This review highlights the importance of rhythmic oscillations of glucocorticoid concentrations for maintaining optimal cognitive, metabolic, cardiovascular and immune functions.

Comment: In this review, the authors explain why rhythmic oscillations of glucocorticoids are essential for maintaining optimal cognitive, metabolic, cardiovascular, and immune functions. These oscillations ensure the continuous dynamic balance required for effective hormonal homeostasis. Disruptions to these rhythms, such as those caused by conventional glucocorticoid therapy, are associated with well-documented adverse effects on mood, appetite, and metabolic regulation. Drawing on both rodent and human studies, the authors emphasize the physiological importance of preserving natural hormone patterns. The review also highlights the shortcomings of current steroid therapies, which often fail to mimic these natural rhythms and suggests that the physiological hormone patterns of glucocorticoid treatment and hormone replacement should be a much higher priority for endocrinologists and the pharmaceutical industry. The review also discusses promising new technologies, such as 24-hour cortisol monitoring, that offer valuable tools for optimizing treatment and advancing personalized hormone replacement strategies.