Comparison of different regimens of glucocorticoid replacement therapy in patients with hypoadrenalism

L. Barbetta, C. Dall'Asta, T. Re, R. Libè, E. Costa, B. Ambrosi

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)632-637
Number of pages6
JournalJournal of Endocrinological Investigation
Volume28
Issue number7
Publication statusPublished - 2005

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Adrenal Insufficiency
Glucocorticoids
Hydrocortisone
Therapeutics
Addison Disease
Cortisone
cortisone acetate

Keywords

  • Cortisol
  • Cortisone
  • Glucocorticoid therapy
  • Hypoadrenalism

ASJC Scopus subject areas

  • Endocrinology

Cite this

Comparison of different regimens of glucocorticoid replacement therapy in patients with hypoadrenalism. / Barbetta, L.; Dall'Asta, C.; Re, T.; Libè, R.; Costa, E.; Ambrosi, B.

In: Journal of Endocrinological Investigation, Vol. 28, No. 7, 2005, p. 632-637.

Research output: Contribution to journalArticle

Barbetta, L. ; Dall'Asta, C. ; Re, T. ; Libè, R. ; Costa, E. ; Ambrosi, B. / Comparison of different regimens of glucocorticoid replacement therapy in patients with hypoadrenalism. In: Journal of Endocrinological Investigation. 2005 ; Vol. 28, No. 7. pp. 632-637.
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