Estudo comparativo do uso de prednisolona versus acetato de hidrocortisona no tratamento da hiperplasia adrenal congênita por deficiência da 21-hidroxilase forma clássica

Leite, Flavia M; Longui, Carlos Alberto; Kochi, Cristiane; Faria, Cláudia Dutra Costantin; Borghi, Mauro; Calliari, Luis Eduardo P.; Monte, Osmar

doi:10.1590/s0004-27302008000100014

Cited by 7 publications

(6 citation statements)

References 42 publications

(53 reference statements)

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“…Several of the included studies assessed the impact of glucocorticoid treatment regimens on final height [15, 16, 19]. Bonfig et al [15] found that prednisolone treatment was associated with higher hydrocortisone-equivalent doses and significantly reduced final height when compared with hydrocortisone.…”

Section: Resultsmentioning

confidence: 99%

Glucocorticoid Regimens in the Treatment of Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis

Whittle

Falhammar

2019

Journal of the Endocrine Society

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Management of congenital adrenal hyperplasia (CAH) requires both glucocorticoid replacement and suppression of adrenal androgen synthesis. It is recommended that children with CAH be treated with hydrocortisone, but the appropriate glucocorticoid regimen in adults is uncertain. In order to review the outcomes of different glucocorticoid regimens in the management of CAH, a systematic search of PubMed/MEDLINE and Web of Science was conducted, including reports published up to 25 February 2019. Studies that compared at least two types of glucocorticoid preparation were included. The following information was extracted from each study: first author, year of publication, number and characteristics of patients and control subjects, types and doses of glucocorticoid regimen used, study design and outcomes [ e.g., biochemical tests, weight, height, body mass index (BMI), bone mineral density (BMD)]. A total of 23 studies were included in the qualitative synthesis, with 19 included in the quantitative synthesis. Dexamethasone was associated with the greatest degree of adrenal suppression; there was no significant difference in 17-hydroxyprogesterone (17OHP) and androstenedione levels between patients treated with hydrocortisone or prednisolone. Patients treated with dexamethasone had the lowest BMD and the highest BMI. Although dexamethasone therapy is associated with significantly lower 17OHP and androstenedione levels, it is also associated with more adverse effects. There do not appear to be significant differences between hydrocortisone and prednisolone therapy, and the choice of agent should be based on individual patient factors.

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Section: Resultsmentioning

confidence: 99%

Glucocorticoid Regimens in the Treatment of Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis

Whittle

Falhammar

2019

Journal of the Endocrine Society

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“…At 1 year of follow up better improvements were shown in suppression of steroid levels and in control of skeletal maturation advancement. On the other hand, a similar study 77 performed on 15 pediatric patients showed no difference between prednisolone and HC; the efficacy between the two regimens being comparable.…”

Section: Standard Glucocorticoid Therapymentioning

confidence: 61%

Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency

Oprea

Bonnet

Pollé

et al. 2019

Therapeutic Advances in Endocrinology

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Adrenal insufficiency is defined as impaired adrenocortical hormone synthesis. According to its source, the deficit is classified as primary (adrenal steroidogenesis impairment), secondary (pituitary adrenocorticotropic hormone deficit) or tertiary (hypothalamic corticotropin-releasing hormone deficit). The management of adrenal insufficiency resides primarily in physiological replacement of glucocorticoid secretion. Standard glucocorticoid therapy is shrouded in several controversies. Along the difficulties arising from the inability to accurately replicate the pulsatile circadian cortisol rhythm, come the uncertainties of dose adjustment and treatment monitoring (absence of reliable biomarkers). Furthermore, side effects of inadequate replacement significantly hinder the quality of life of patients. Therefore, transition to circadian hydrocortisone therapy gains prominence. Recent therapeutic advancements consist of oral hydrocortisone modified-release compounds (immediate, delayed and sustained absorption formulations) or continuous subcutaneous hydrocortisone infusion. In addition to illustrating the current knowledge on conventional glucocorticoid regimens, this review outlines the latest research outcomes. We also describe the management of pediatric patients and suggest a novel strategy for glucocorticoid replacement therapy in adults.

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“…Single dose of prednisolone was effective in control of disease in CAH comparable to hydrocortisone. [ 9 14 15 ] Small sample size, wide age group and differing severity of CAH are important factors that limit meaningful interpretation of these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies showed different bioequivalent doses of hydrocortisone with respect to the androgen suppression properties. [ 9 13 14 15 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of different glucocorticoid regimens in the management of classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Ajish

Pavithran

Nisha

et al. 2014

Indian J Endocr Metab

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Background:There are recommendations regarding the total dose of hydrocortisone to be administered in the treatment of classical congenital adrenal hyperplasia (CAH) to achieve the twin objectives of glucocorticoid replacement and control of hyperandrogenism. However, there is evidence gap regarding the breakup, timing and type of the steroid regimen.Objectives:Efficacy of three different glucocorticoid regimens having the same total dose of steroid, differing in either the timing or type of evening steroid administered, in achieving biochemical control of the disease was assessed.Materials and Methods:The study was done in 13 prepubertal children with classical CAH over a 6-month period with 2 months devoted to each regimen. We used a prospective cross-over design using 10-15 mg/m2 total dose of hydrocortisone. Two-fifths of the total dose of hydrocortisone was administered in the morning and one-fifth of the total dose was administered at noon in all the regimens. The regimens differed in the timing of the evening dose of hydrocortisone, 06.00-07.00 pm in regimen 1 and 09.00-10.00 pm in regimen 2. The third regimen had the evening dose of hydrocortisone replaced by an equivalent dose of prednisolone suspension which was administered at 10.00 pm. Serum 17-hydroxyprogesterone and testosterone levels were compared to assess the efficacy of treatment regimens.Results:The three different regimens were found to be similar in their ability to control 17-hydroxyprogesterone and testosterone levels. The percentage of patients with predefined criteria for biochemically controlled disease was similar in all the three regimens. However, there was a trend toward better control of 17-hydroxyprogesterone levels in patients receiving evening dose of prednisolone.Conclusions:There is no significant advantage in administering the hydrocortisone dose late at night in patients with classical CAH.

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Estudo comparativo do uso de prednisolona versus acetato de hidrocortisona no tratamento da hiperplasia adrenal congênita por deficiência da 21-hidroxilase forma clássica

Cited by 7 publications

References 42 publications

Glucocorticoid Regimens in the Treatment of Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis

Glucocorticoid Regimens in the Treatment of Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis

Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency

Comparison of different glucocorticoid regimens in the management of classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency

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