Optimising glucocorticoid replacement therapy in severely adrenocorticotropin (ACTH) deficient hypopituitary male patients.

Hdl Handle:
http://hdl.handle.net/10147/132311
Title:
Optimising glucocorticoid replacement therapy in severely adrenocorticotropin (ACTH) deficient hypopituitary male patients.
Authors:
Behan, Lucy-Ann; Rogers, Bairbre; Hannon, Mark J; O'Kelly, Patrick; Tormey, William; Smith, Diarmuid; Thompson, Christopher J; Agha, Amar
Affiliation:
Division of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin, Ireland Department of Statistics, Beaumont Hospital, Dublin, Ireland Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland.
Citation:
Optimising glucocorticoid replacement therapy in severely adrenocorticotropin (ACTH) deficient hypopituitary male patients. 2011:notClin Endocrinol (Oxf)
Journal:
Clinical endocrinology
Issue Date:
18-Apr-2011
URI:
http://hdl.handle.net/10147/132311
DOI:
10.1111/j.1365-2265.2011.04074.x
PubMed ID:
21521342
Additional Links:
http://www.ncbi.nlm.nih.gov/pubmed/21521342
Abstract:
Context:  The optimal replacement regimen of hydrocortisone in adults with severe ACTH deficiency remains unknown. Management strategies vary from treatment with 15mg to 30mg or higher in daily divided doses, reflecting the paucity of prospective data on the adequacy of different glucocorticoid regimens. Objective:  Primarily to define the hydrocortisone regimen which results in a 24hour cortisol profile that most closely resembles that of healthy controls and secondarily to assess the impact on quality of life (QoL). Design:  10 male hypopituitary patients with severe ACTH deficiency (basal cortisol <100nM and peak response to stimulation <400nM) were enrolled in a prospective, randomised, crossover study of 3 hydrocortisone dose regimens. Following 6 weeks of each regimen patients underwent 24hour serum cortisol sampling and QoL assessment with the Short Form 36 and the Nottingham Health Profile questionnaires. Free cortisol was calculated using Coolen's equation. All results were compared to those of healthy, matched controls. Results:  CBG was significantly lower across all dose regimens compared to controls (p<0.05). The lower dose regimen C(10mg mane/5mg tarde) produced a 24hour free cortisol profile which most closely resembled that of controls. Both regimen A(20mg mane/10mg tarde) and B(10mg mane/10mg tarde) produced supraphysiological post-absorption peaks. There was no significant difference in QoL in patients between the three regimens, however energy level was significantly lower across all dose regimens compared to controls (p<0.001). Conclusions:  The lower dose of HC(10mg/5mg) produces a more physiological cortisol profile, without compromising quality of life, compared to higher doses still used in clinical practice. This may have important implications in these patients, known to have excess cardiovascular mortality.
Item Type:
Article
Language:
en
ISSN:
1365-2265

Full metadata record

DC FieldValue Language
dc.contributor.authorBehan, Lucy-Annen
dc.contributor.authorRogers, Bairbreen
dc.contributor.authorHannon, Mark Jen
dc.contributor.authorO'Kelly, Patricken
dc.contributor.authorTormey, Williamen
dc.contributor.authorSmith, Diarmuiden
dc.contributor.authorThompson, Christopher Jen
dc.contributor.authorAgha, Amaren
dc.date.accessioned2011-05-30T07:56:21Z-
dc.date.available2011-05-30T07:56:21Z-
dc.date.issued2011-04-18-
dc.identifier.citationOptimising glucocorticoid replacement therapy in severely adrenocorticotropin (ACTH) deficient hypopituitary male patients. 2011:notClin Endocrinol (Oxf)en
dc.identifier.issn1365-2265-
dc.identifier.pmid21521342-
dc.identifier.doi10.1111/j.1365-2265.2011.04074.x-
dc.identifier.urihttp://hdl.handle.net/10147/132311-
dc.description.abstractContext:  The optimal replacement regimen of hydrocortisone in adults with severe ACTH deficiency remains unknown. Management strategies vary from treatment with 15mg to 30mg or higher in daily divided doses, reflecting the paucity of prospective data on the adequacy of different glucocorticoid regimens. Objective:  Primarily to define the hydrocortisone regimen which results in a 24hour cortisol profile that most closely resembles that of healthy controls and secondarily to assess the impact on quality of life (QoL). Design:  10 male hypopituitary patients with severe ACTH deficiency (basal cortisol <100nM and peak response to stimulation <400nM) were enrolled in a prospective, randomised, crossover study of 3 hydrocortisone dose regimens. Following 6 weeks of each regimen patients underwent 24hour serum cortisol sampling and QoL assessment with the Short Form 36 and the Nottingham Health Profile questionnaires. Free cortisol was calculated using Coolen's equation. All results were compared to those of healthy, matched controls. Results:  CBG was significantly lower across all dose regimens compared to controls (p<0.05). The lower dose regimen C(10mg mane/5mg tarde) produced a 24hour free cortisol profile which most closely resembled that of controls. Both regimen A(20mg mane/10mg tarde) and B(10mg mane/10mg tarde) produced supraphysiological post-absorption peaks. There was no significant difference in QoL in patients between the three regimens, however energy level was significantly lower across all dose regimens compared to controls (p<0.001). Conclusions:  The lower dose of HC(10mg/5mg) produces a more physiological cortisol profile, without compromising quality of life, compared to higher doses still used in clinical practice. This may have important implications in these patients, known to have excess cardiovascular mortality.-
dc.languageENG-
dc.language.isoenen
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/21521342en
dc.titleOptimising glucocorticoid replacement therapy in severely adrenocorticotropin (ACTH) deficient hypopituitary male patients.en
dc.typeArticleen
dc.contributor.departmentDivision of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin, Ireland Department of Statistics, Beaumont Hospital, Dublin, Ireland Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland.en
dc.identifier.journalClinical endocrinologyen
dc.description.provinceLeinster-

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