Higher glucocorticoid replacement doses are associated with increased mortality in patients with pituitary adenoma

Abstract

Patients with NFPA and AI receiving more than 20 mg HCeq per day have an increased mortality. Our data also show that mortality in patients substituted with 20 mg HCeq per day or less is not increased.

High prescription rate of oral glucocorticoids in children and adults: A retrospective cohort study from Western Sweden

“…As an endocrinologist, the aim is to use 20 mg of hydrocortisone daily as a replacement dose for patients with adrenal insufficiency, although the daily doses may be much higher when you are treating other diseases. 7,35 The definition of prednisolone equivalent dose in our inclusion criteria differs from the DDD definition. Betamethasone causes more profound suppression of the hypothalamic-pituitary-adrenal axis than an equivalent anti-inflammatory dose of prednisolone.…”

Improved insulin sensitivity and secretion in prediabetic patients with adrenal insufficiency on dual‐release hydrocortisone treatment: a 36‐month retrospective analysis

“…Many studies have shown that conventional GC replacement therapy is associated with reduced life expectancy and increased morbidity in patients with AI, compared to the general population . In a recent survey on 1281 participants, conventional GC treatment was demonstrated to be associated with impaired quality of life, fatigue, high absenteeism from work or school and a high rate of hospitalization for adrenal crises, vomiting or acute infections .…”

Management of hypothalamic disease in patients with craniopharyngioma

“…Symptomatic hyponatraemia secondary to ACTH deficiency may be identified at presentation with CP . ACTH deficiency and higher dose of hydrocortisone replacement therapy (>25 mg/d in acromegaly; >20 mg/d in NFPA patients) in other pituitary disorders are associated with increased mortality, but these associations have not been studied specifically in CP cohorts . In studies using cortisol day curves, hydrocortisone doses of 10 mg in the morning and 5 mg in the early afternoon were the best approximation to physiological replacement in adult patients; however, there is no outcome‐based research in support of any one hydrocortisone dose at present …”