In this episode of MD Newsline, Dr. Sassan Mirfakhraee, adult endocrinologist and associate professor at the University of Texas Southwestern Medical Center, shares groundbreaking insights into the management of adrenal insufficiency. At the Endocrine 2025 conference, Dr. Mirfakhraee presented his research on utilizing insulin pumps to deliver hydrocortisone—an innovative off-label approach that is showing promising results for patients who remain symptomatic on oral therapy.

He explains how this strategy better mimics the body's natural cortisol rhythm, improves quality of life, and reduces ER visits and hospitalizations for patients with persistent symptoms. Dr. Mirfakhraee also outlines patient selection criteria, training protocols, safety considerations, and the potential for remote monitoring via pump data.

This conversation highlights the importance of personalized care in endocrinology, bridging innovation with clinical practice to improve outcomes for patients with challenging conditions.

Episode Highlights:

New Approach to Adrenal Insufficiency

Dr. Mirfakhraee introduces the use of insulin pumps for hydrocortisone infusion, addressing limitations of oral steroids that often fail to fully resolve symptoms.

Mimicking Cortisol's Natural Rhythm

The pump allows for overnight delivery and tailored boluses, reducing symptoms such as dizziness, nausea, fatigue, and morning crashes that patients often face with oral therapy.

Patient Selection and Benefits

He outlines which patients may benefit most—those with persistent symptoms, frequent adrenal crises, malabsorption issues, or shift-work challenges—while ensuring other conditions are ruled out.

Remote Monitoring and Safety

Insulin pumps enable cloud-based data sharing, allowing clinicians to monitor dosing, adjustments, and stress dosing remotely. While generally safe, clinicians must remain vigilant for issues like skin infections or infusion interruptions.

Training and Quality of Life

Through support from diabetes educators, patients learn how to manage pump settings and troubleshoot. Many report dramatic improvements—returning to work, engaging in family life, and regaining independence.

Future Research Needs

Dr. Mirfakhraee stresses the need for standardized pump settings, broader data collection, and insurance approval pathways to make this therapy more accessible.

Key Takeaway:

Insulin pump-based hydrocortisone delivery offers a promising new avenue for patients with adrenal insufficiency who remain symptomatic on oral therapy. By improving quality of life, reducing crises, and allowing for tailored dosing, this approach may represent a paradigm shift in endocrine care.

Resources:

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