From the Research
Vitamin D deficiency is common in patients with adrenal insufficiency and should be routinely screened for and treated, with a target level of above 30 ng/mL (75 nmol/L) to prevent morbidity and mortality. The connection between adrenal insufficiency and vitamin D deficiency stems from several factors, including the role of cortisol in regulating calcium and vitamin D metabolism 1. When cortisol production is inadequate, vitamin D activation and calcium absorption may be impaired. Additionally, patients with autoimmune adrenal insufficiency (Addison's disease) often have other autoimmune conditions that can affect vitamin D status. Some studies suggest that vitamin D may have a role in adrenal gland disorders, including adrenal insufficiency, although the evidence is still limited and inconclusive 2, 3. Proper vitamin D supplementation is particularly important in these patients as it helps maintain bone health, immune function, and may help reduce the risk of other autoimmune conditions. For those with deficiency, supplementation typically involves vitamin D3 (cholecalciferol) at doses of 1,000-2,000 IU daily for maintenance or 50,000 IU weekly for 8-12 weeks followed by maintenance dosing for more severe deficiency, as suggested by the majority of experts 4. Regular monitoring of vitamin D levels every 6-12 months is recommended to ensure adequate supplementation. It is also important to note that vitamin D deficiency has been associated with increased morbidity and mortality in critically ill children, highlighting the importance of adequate vitamin D levels in this population 5. Overall, maintaining adequate vitamin D levels is crucial for patients with adrenal insufficiency to prevent morbidity and mortality, and supplementation should be tailored to individual patient needs.