The Effect of Different Treatment Regimens on Hormonal Profiles in Congenital Adrenal Hyperplasia

Chronopharmacology of hydrocortisone and 9?-fluorhydrocortisone in the treatment for congenital adrenal hyperplasia

“…In our hands, however, such high total doses without exception induced Cushing-like symptoms. Smith et al [6] found no advantage in replacing the afternoon dose of a twice-a-day hydrocortisone schedule by an equivalent nocturnal dose of dexamethasone. On the other hand, dosage schedules not corresponding to the circadian rhythm do enhance the risk of Cushing-like side effects in animal models [7], indicating that late or high evening doses should be avoided.…”

Steroid Replacement in Addison's Disease and in Subjects Adrenalectomized for Cushing's Disease: Comparison of Various Glucocorticoids*

“…Particularly in the treatment of congenital adrenal hyperplasia, sustained normalization of plasma ACTH becomes an important therapeutic objective (4,(11)(12)(13), but in order to allow maximum skeletal growth, it is an advantage to control ACTH secretion with minimum doses of glucocorticoid. Treatment with a longer-acting glucocorticoid may be preferable in achieving this objective, provided that precise dose equivalence can be established.…”

“…Glucocorticoids with greater potency and more sustained action than hydrocortisone are widely available; these produce greater suppression of endogenous steroids and ACTH secretion (4,7,(13)(14)(15)(16). However, their long term value is not yet established, and their relative potency in humans is still uncertain due to indirect determinations of dose equivalence (17,18).…”

A review of the effects of therapy on growth and bone mineralization in children with congenital adrenal hyperplasia

“…Hydrocortisone has traditionally been used because of its short half-life and presumed lesser effect on the hypothalamic-pituitary growth axis. Controversy remains whether hydrocortisone should be administered 2 or 3 times per day and how the total daily dose should be divided [22][23][24][25]. Satisfactory growth outcomes have been reported using longer-acting preparations such as prednisone [26] and dexamethasone [27].…”