Effect of hydrocortisone dose schedule on adrenal steroid secretion in congenital adrenal hyperplasia

Winterer, Jorg; Chrousos, George P.; Loriaux, D. Lynn; Cutler, Gordon B.

doi:10.1016/s0022-3476(85)80486-8

Cited by 35 publications

(27 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The total daily dose, however, was not more than 12.5 mg hydrocortisone per m 2, which was lower than ours [8].…”

Section: Discussioncontrasting

confidence: 80%

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

Moêller

1985

Eur J Pediatr

View full text Add to dashboard Cite

The conventional treatment of CAH with hydrocortisone (16-19 mg/m2 per day) and 9 alpha-F-cortisol (just enough to normalise renin concentrations, started at 07:00 h) was ineffective in suppressing the early morning rise of 17-OH-progesterone and in turn androgens in about 20% of our patients. The present work explored the effect of a modified dosage regimen of the drug in five patients. The schedule was: 03:00 h F 33% + 9 alpha-F-F 33%; 07:00 h F 30%; 12:00 h F 22% + 9 alpha-F-F 33%; 17:30 h F 15% + 9 alpha-F-F 33%. Monitored levels of circulating 17-OH-progesterone, testosterone, and individual urinary 17-ketosteroids showed significant improvement, which was not achieved by giving higher or later evening doses. Menarche was induced in two girls (bone age 15 years). The modified dosage schedule offers on the one hand the possibility of better management of CAH, and on the other, cuts down the risk of enhanced Cushing-like effects, which in animal models have been related frequently to dosage schedules not corresponding to the circadian rhythm. The difficulty of administering the drugs at 03:00 h should be overcome by the development of a late-releasing preparation.

show abstract

“…The total daily dose, however, was not more than 12.5 mg hydrocortisone per m 2, which was lower than ours [8].…”

Section: Discussioncontrasting

confidence: 80%

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

Moêller

1985

Eur J Pediatr

View full text Add to dashboard Cite

show abstract

“…Traditional dogma suggests that prepubertal children should be treated with a hydrocortisone dose divided twice or thrice daily and the degree of control should be assessed by monitoring 17-hydroxyprogsterone, androstenedione, and possibly testosterone levels [9, 10]. Invariably, the greatest apparent adrenal androgen suppression occurs 2–4 hours after each dose [11], and the duration of this suppressive effect is limited. Also, standard treatment with two or three daily doses of corticosteroids [12], treatment with different prednisone regimens [13], and even nocturnal administration of the total daily dose of hydrocortisone [11] do not prevent a pronounced rise in 17-hydroxyprogesterone level after midnight, reflecting lack of effective suppression of the nocturnal ACTH peak.…”

Section: Discussionmentioning

confidence: 99%

“…Invariably, the greatest apparent adrenal androgen suppression occurs 2–4 hours after each dose [11], and the duration of this suppressive effect is limited. Also, standard treatment with two or three daily doses of corticosteroids [12], treatment with different prednisone regimens [13], and even nocturnal administration of the total daily dose of hydrocortisone [11] do not prevent a pronounced rise in 17-hydroxyprogesterone level after midnight, reflecting lack of effective suppression of the nocturnal ACTH peak. However, when hydrocortisone is administered at 03:00 AM at 33% of the total daily dose, a marked reduction in the morning serum 17-hydroxyprogesterone levels is observed [14], indicating adequate suppression of the early morning rise in ACTH.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Dexamethasone versus Hydrocortisone for the Treatment of Children with Congenital Adrenal Hyperplasia

Dauber

Feldman

Majzoub

2010

International Journal of Pediatric Endocrinology

View full text Add to dashboard Cite

Classic congenital adrenal hyperplasia affects approximately 1 in 15,000 children. Current treatment strategies using multiple daily doses of hydrocortisone lead to suboptimal outcomes. We tested the hypothesis that nocturnal administration of dexamethasone will suppress the hypothalamic-pituitary-adrenal axis more effectively than standard hydrocortisone treatment by blocking the inherent diurnal secretion of ACTH. We performed a pilot study of five prepubertal patients comparing CAH control during two 24-hour hospitalizations, one on hydrocortisone and the other on dexamethasone. The patterns of adrenal suppression differed markedly between hydrocortisone and nocturnal dexamethasone, with significant suppression of the morning rise in ACTH, 17-hydroxyprogesterone, and androstenedione while on dexamethasone. On hydrocortisone therapy, there is a marked variation in ACTH and adrenal hormones depending on time of day and timing of hydrocortisone administration. Longer-term studies are needed to investigate the lowest effective dose and potential toxicity of nocturnal dexamethasone to determine its utility as a therapy for CAH.

show abstract

“…Uma vez que os sinais clínicos não são evidentes em curto prazo de avaliação, o controle terapêutico para a deficiência da 21OHase inclui a avaliação de esteróides séricos, como a 17-hidroxiprogesterona e a androstenediona. Entretanto, a interpretação da 17OHP deve ser cuidadosa, uma vez que a mesma possui variação circardiana substancial e a tentativa de normalizar sua concentração pode induzir ao uso excessivo de GC (34,(45)(46)(47). Neste estudo, a quantificação da 17OHP permaneceu anormalmente elevada em ambos os protocolos de tratamentos, sendo pouco maior no período em que se utilizou a prednisolona.…”

Section: Discussionunclassified

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

Leite

Longui

Kochi

et al. 2008

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

RESUMOO tratamento da hiperplasia adrenal congênita (HAC) por deficiência da 21-hidroxilase forma clássica é habitualmente realizado com acetato de hidrocortisona. A hidrocortisona oral, em nosso meio, só está disponível em farmá-cias de manipulação. A prednisolona possui solução oral estável, comercialmente disponível, e tem como vantagem poder ser utilizada em dose única diária. O objetivo desse estudo foi comparar a eficácia da prednisolona aos resultados obtidos com o acetato de hidrocortisona. Foram estudados 15 pacientes, idade cronológica média (DP) de 7,2 anos (3,6), em dois períodos consecutivos de um ano, inicialmente utilizando a hidrocortisona (17,5 mg/m²/dia, divididos em três doses), seguida do uso de prednisolona (3 mg/m²/dia, dose única matinal). A avaliação dos tratamentos foi realizada por meio das variações do escore Z de estatura para idade cronológica ( ZE), do escore Z de estatura para a idade óssea ( ZEIO) e do escore Z do Índice de massa corporal (IMC) ( ZIMC), bem como os valores da androstenediona em cada período. Não houve diferença na ZE, na ZEIO e na ZIMC entre os dois períodos, assim como nos valores de androstenediona. Concluiu-se que a prednisolona em dose única diária apresenta eficácia semelhante à obtida com a hidrocortisona utilizada três vezes ao dia, podendo ser considerada uma opção terapêutica nos pacientes com HAC por deficiência da 21-hidroxilase. Hydrocortisone acetate is usually employed in the treatment of classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. In Brazil, however, oral hydrocortisone acetate is only available from manipulation pharmacies. Prednisolone has stable oral pharmaceutical formulations commercially available, with the advantage of a single daily dose. The aim of this study was to compare the efficacy of oral prednisolone and oral hydrocortisone in the treatment of CAH due to 21-hydroxylase deficiency. Fifteen patients with mean (SD) chronological age of 7.2 (3.6) years, were evaluated in two consecutive 1-year periods. In the first year, hydrocortisone (17.5mg/m²/ day, divided in three doses) was used in the treatment, followed by the use of prednisolone (3 mg/m²/day, once in the morning) in the second year. The comparison between the two treatments was assessed after a one-year treatment period by: variation of height standard deviation score (SDS) ( Height SDS), variation of height SDS according to bone age ( BA SDS), variation of body mass SDS ( BMI SDS) and serum levels of androstenedione. No significant difference was observed in relation to the Height SDS, BA SDS

show abstract

Effect of hydrocortisone dose schedule on adrenal steroid secretion in congenital adrenal hyperplasia

Cited by 35 publications

References 8 publications

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

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

Nocturnal Dexamethasone versus Hydrocortisone for the Treatment of Children with Congenital Adrenal Hyperplasia

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

Contact Info

Product

Resources

About