Autoimmune Addison's disease (AAD) is a rare and debilitating disease in which an autoimmune
attack progressively destroys the adrenal cortex. Untreated it is universally fatal and
treated people are absolutely dependent upon steroid medications lifelong, with a consequent
excess in morbidity and mortality. A key feature of the adrenal cortex is that its cells are
responsive to changes in circulating adrenocorticotrophic hormone (ACTH) concentration. This
study aims to regenerate adrenocortical steroidogenic cell function in patients with
established autoimmune Addison's disease (AAD) by stimulating proliferation and
differentiation of their progenitor cells, the adrenocortical stem cells (ACSCs) (1,2). Using
daily subcutaneous ACTH, administered according to two different regimens over 20 weeks, we
will investigate whether regeneration of adrenal steroidogenic function through revival of
ACSC activity is a realistic possibility.