A related commentary discusses this research. The novel finding from this study is the effect of circadian glucocorticoid administration on the immune system in patients with adrenal insufficiency. A switch to once-daily, modified-release hydrocortisone was associated with a progressive reduction in the number of classic pro-inflammatory monocytes. Additionally, the number of mild infections was reduced in patients allocated to once-daily, modified release hydrocortisone.
Quality of life was also improved in the switch treatment group, as measured with the Addison’s disease-specific quality of- life questionnaire. However, the study participants were not masked to treatment allocation, reducing the validity of this finding. A further limitation of the study is the heterogeneous population, including both patients with primary and secondary adrenal insufficiency.