The investigators have shown that patients with adrenal insufficiency (Addison's disease), a
rare disorder, have doubled the expected mortality rate in Sweden despite Standard of Care
glucocorticoid (GC) replacement. One % of the Swedish population are, however, receiving GCs
for inflammatory diseases, but management is empirical and adjusted to underlying disease
activity. The desired anti-inflammatory therapeutic effects cannot be differentiated from the
adverse metabolic (osteoporosis, obesity, diabetes mellitus) and immunosuppressive side
effects of GC. This frequently results in suboptimal GC therapy with adverse effects due to
over-dosing or poor efficacy due to under-dosing. The primary aim is to identify a biomarker
for the metabolic effects of GCs. Patients with Addison's disease completely lack endogenous
GCs and can therefore be considered a human GC knock-out model. They can therefore be studied
during near-physiological exposure and during GC starvation. This will uniquely allow a very
clean biomarker identification model (using transcriptomics, proteomics and metabolomics).
The secondary aim is to validate candidate biomarker(s) in a dose-response study using the
same patient population. A biomarker of GC actions will make it possible to individualised
therapy during pharmacological GC treatment. It would allow GC replacement to be monitored in
Addison's disease and could become a specific diagnostic tool in patients with GC deficiency
and excess (Cushings syndrome).