Document Detail

Comparison of different regimens of glucocorticoid replacement therapy in patients with hypoadrenalism.
MedLine Citation:
PMID:  16218046     Owner:  NLM     Status:  MEDLINE    
Since the optimal glucocorticoid replacement needs to avoid over and under treatment, the adequacy of different daily cortisone acetate (CA) doses was assessed in 34 patients with primary and central hypoadrenalism. The conventional twice CA 37.5 mg/day dose was administered to all patients (A regimen: 25 mg at 07:00 h, 12.5 mg at 15:00 h), while in 2 subgroups of 12 patients the dose was shifted on 2 thrice daily regimens (B: 25 mg at 07:00, 6.25 mg at 12: 00, 6.25 mg at 17:00; C: 12.5 mg, 12.5 mg, 12.5 mg). In other 12 patients the conventional dose was reduced to a thrice 25 mg/day administration (D regimen: 12.5 mg, 6.25 mg, 6.25 mg). In all patients, urinary free cortisol (UFC) excretion and cortisol day curves were evaluated. During the CA 37.5 mg administration, nadir cortisol levels were significantly higher with the thrice daily regimens (143 +/- 31 on B and 151 +/- 34 nmol/l on C) than with the conventional twice (85 +/- 16 nmol/l). Moreover, UFC, morning cortisol levels and mean cortisol day curves were similar in each group. Finally, during D regimen nadir cortisol levels were higher than in A and similar to B and C regimens. No difference in UFC and in cortisol day curves by reducing the CA dose was found. In conclusion, the thrice daily cortisone regimens, in which more physiological cortisol levels are achieved, perform better as replacement therapy. The administration of 25 mg/day CA confirms that replacement therapy is more adequate with a lower dose, particularly in patients with central hypoadrenalism.
L Barbetta; C Dall'Asta; T Re; R Libè; E Costa; B Ambrosi
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of endocrinological investigation     Volume:  28     ISSN:  0391-4097     ISO Abbreviation:  J. Endocrinol. Invest.     Publication Date:    2005 Jul-Aug
Date Detail:
Created Date:  2005-10-12     Completed Date:  2006-01-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7806594     Medline TA:  J Endocrinol Invest     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  632-7     Citation Subset:  IM    
Endocrinology Unit, Department of Medical and Surgical Sciences, Istituto Policlinico San Donato, University of Milano, Milano, Italy.
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MeSH Terms
Adrenal Insufficiency / drug therapy*
Cortisone / administration & dosage,  analogs & derivatives,  therapeutic use
Drug Administration Schedule
Glucocorticoids / administration & dosage*,  therapeutic use*
Hormone Replacement Therapy*
Hydrocortisone / blood,  urine
Middle Aged
Reg. No./Substance:
0/Glucocorticoids; 50-04-4/cortisone acetate; 50-23-7/Hydrocortisone; 53-06-5/Cortisone

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