Long-Acting Hydrocortisone for Glucocorticoid Replacement Therapy

Johannsson, Gudmundur; Filipsson, Helena; Bergthorsdottir, Ragnhildur; Lennernäs, Hans; Skrtic, Stanko

doi:10.1159/000110621

Cited by 19 publications

(8 citation statements)

References 78 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The low level of surveillance for mineralocorticoid deficiency could have resulted in suboptimal treatment of patients with combined mineralocorticoid deficiency, in particular, of those receiving prednisolone. Furthermore, the fludrocortisone treatment rate (27.1%) was significantly lower in this study than in studies from other countries (70% to 90%) [ 7 24 25 ]. Therefore, we recommend active surveillance for mineralocorticoid status at diagnosis.…”

Section: Discussioncontrasting

confidence: 81%

Characteristics of Korean Patients with Primary Adrenal Insufficiency: A Registry-Based Nationwide Survey in Korea

et al. 2017

View full text Add to dashboard Cite

BackgroundPrimary adrenal insufficiency (PAI) is a rare, potentially life-threatening condition. There are few Korean studies on PAI, and most have had small sample sizes. We aimed to examine the etiology, clinical characteristics, treatment, and mortality of PAI in Korean patients.MethodsA nationwide, multicenter, registry-based survey was conducted to identify adults diagnosed with or treated for PAI at 30 secondary or tertiary care institutions in Korea between 2000 and 2014.ResultsA total of 269 patients with PAI were identified. The prevalence of PAI was 4.17 per million. The estimated incidence was 0.45 per million per year. The mean age at diagnosis was 49.0 years, and PAI was more prevalent in men. Adrenal tuberculosis was the most common cause of PAI in patients diagnosed before 2000; for those diagnosed thereafter, adrenal metastasis and tuberculosis were comparable leading causes. The etiology of PAI was not identified in 34.9% of cases. Of the patients receiving glucocorticoid replacement therapy, prednisolone was more frequently administered than hydrocortisone (69.4% vs. 26.5%, respectively), and only 27.1% of all patients received fludrocortisone. We observed an increased prevalence of metabolic disease and osteoporosis during the follow-up period (median, 60.2 months). The observed overall mortality and disease-specific mortality rates were 11.9% and 3.1%, respectively.ConclusionThe prevalence of PAI is significantly lower in Koreans than in reports from Western countries. The high frequency undetermined etiology in patients with PAI suggests the need to reveal accurate etiology of PAI in Korea.

show abstract

Section: Discussioncontrasting

confidence: 81%

Characteristics of Korean Patients with Primary Adrenal Insufficiency: A Registry-Based Nationwide Survey in Korea

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Third, the high 08.00 am plasma cortisol concentration and its secondary decrease during the 08.00–10.00 am time period observed in healthy volunteers contrasts with the low undetectable baseline plasma cortisol concentration and secondary rise after hydrocortisone intake in patients, resulting in a shift of cortisol AUC between both groups which may hamper the accuracy of their comparative measurements. New formulations of modified-release hydrocortisone tablets may help obtaining a more physiological and stable circadian cortisol profile [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Time-Point Serum Cortisol and ACTH Measurements for the Adjustment of Glucocorticoid Replacement in Adrenal Insufficiency

et al. 2015

View full text Add to dashboard Cite

BackgroundAdjustment of daily hydrocortisone dose on clinical criteria lacks sensitivity for fine tuning. Long term hydrocortisone (HC) over-replacement may lead to increased morbidity and mortality in patients with adrenal insufficiency (AI). Biochemical criteria may help detecting over- or under-replacement but have been poorly evaluated.MethodsMulticenter, institutional, pharmacokinetic study on ACTH and cortisol plasma profiles during HC replacement in 27 AI patients compared to 29 matched controls. All AI patients were administered HC thrice daily at doses of 6, 10 and 14 mg/m2/d. Blood samples were drawn hourly from 0800h to 1900h. The main outcome measures were: i) plasma peak cortisol and cortisol area under the curve (AUC) in AI patients compared to controls, ii) correlations between cortisol AUC vs single-point cortisol or ACTH decrease from baseline (ΔACTH) and iii) the predictive value of the two latters for obtaining AI patients’ cortisol AUC in the control range.ResultsCortisol peaks were observed 1h after each HC intake and a dose response was demonstrated for cortisol peak and cortisol AUC. The comparison of AI patients’ cortisol AUC to controls showed that 81.5% AI patients receiving 6mg/m2/d were adequately replaced, whereas most patients receiving higher doses were over-replaced. The correlation coefficient between 1000h/1400h cortisol concentrations and 0800-1900h cortisol AUC were 0.93/0.88 respectively, whereas the 0800-1200h ΔACTH fairly correlated with 0800-1900h cortisol AUC (R = 0.57). ROC curve analysis indicated that the 1000h and 1400h cortisol concentrations best predicted over-replacement.ConclusionsPatients receiving a 6mg/m2 hydrocortisone daily dose exhibited the most physiological daytime cortisol profile. Single point plasma cortisol correlated with daytime cortisol AUC in AI patients. Although hydrocortisone dose should be currently determined on clinical grounds, our data suggest that single point plasma cortisol may be an adjunct for further hydrocortisone dose adjustment in AI patients.

show abstract

“…We have found it impractical to administer the midday dose to school‐going children, and hence opted for a twice daily hydrocortisone regimen. A long‐acting preparation of hydrocortisone has recently become available, but is not yet available to us 20 …”

Section: Discussionmentioning

confidence: 99%