During the Ramadan, Muslims fast every day, from dawn to sunset, for a whole month. The fast is a stressful period when individuals abstain from eating and drinking and are therefore at risk of dehydration, fainting, low glucose levels, intense thirst, and asthenia. In patients with adrenal insufficiency who are deficient in one of the major metabolic and stress hormones in the body, cortisol, this may be fatal. Daily treatment with glucocorticoids usually hydrocortisone is essential. In the paper by Chihaoui et al. [1], patients with adrenal insufficiency were mostly on twice daily hydrocortisone regimes with the higher dose during fasting administered at the sunset meal and the lower dose at the predawn meal. During Ramadan taking medicine orally is considered breaking the fast….

The development of new formulations of hydrocortisone, with modified release mechanisms, could potentially reduce the risk for complications and adrenal crises during the Ramadan by extending 24-h cortisol exposure and delivering the right amount of cortisol in the appropriate time of the day. Chronocort^®, administered twice daily with the higher dose at sunset and the lower dose at dawn has been shown to approximate the physiological cortisol circadian rhythm [12]. This formulation would allow those patients wanting to fast during the Ramadan respect their obligations and not break the fast…

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