Most patients who have been diagnosed with adrenal insufficiency will be treated with oral medication in the form of a glucocorticoid. This is replacing the cortisol their body is failing to produce with the aim of achieving the greatest possible life quality. There are various medications and regiments available and it may take some time for a patient to find the medication and dosing schedule that works best for them. The aim is always to find a good balance between maximizing a patients’ life quality while limiting any undesirable side-effects.
If a patient has known absorption issues, shows evidence of rapid metabolization of medications or continues to struggle on various oral medication regimens, a cortisol pump may be a viable treatment alternative. The technical term for cortisol pumps in published research papers and medical journals is “continuous subcutaneous hydrocortisone infusion” (CSHI).
In the USA, there is currently no pump available that has been approved by a regulatory agency for the specific purpose of treating adrenal insufficiency. However, the FDA clarifies that “(g)ood medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgment.”* Therefore, cortisol pumping is achieved by using various readily available medication pumps “off-label”, since most have been originally designed or marketed towards use with insulin to treat diabetes.
The medication reservoir gets filled with an injectable form of a glucocorticoid, most commonly Solu-Cortef® (hydrocortisone sodium succinate). The basal program will be designed to mimic the circadian rhythm of a healthy individual. Various studies from around the world have repeatedly demonstrated that CSHI via a cortisol pump is a safe and effective treatment modality for patients that show a poor response to traditional replacement therapy.
The website https://thecortisolpump.com/ contains a lot of resources and addresses a variety of topics from the benefits and challenges of cortisol pumping over required supplies all the way to troubleshooting potential issues.
For peer-to-peer support or to learn from individuals utilizing cortisol pumps, you can request to join the Facebook group “Cortisol Pump Group“.
If you are looking for support in obtaining a pump or supplies due to lack of insurance coverage or insurance denial, please consider contacting our partners at the CR3 Diabetes Association, Inc.
*https://www.fda.gov/regulatory-information/search-fda-guidance-documents/label-and-investigational-use-marketed-drugs-biologics-and-medical-devices
