Hydrocortisone replacement dosage influences intraocular pressure in patients with primary and secondary hypocortisolism

Chong, Jimmy; Sen, Jonathan; Johnson, Zachary R.; Kyle, G; MacFarlane, I. A.

doi:10.1046/j.1365-2265.2001.01200.x

Cited by 16 publications

(13 citation statements)

References 40 publications

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“…The consequences of cortisol deficiency during night time as well as those of the temporary hypercortisolism following the ingestion of hydrocortisone are yet unknown. Possible serious side-effects are osteoporosis (Peacey et al 1997;Wichers et al 2000;Tauchmanová et al 2007), diabetes (McConnell et al 2001) and glaucoma (Li Voon Chon et al 2001). Compared to the normal population, patients with secondary adrenal insufficiency are known to be at greater risk for cardiovascular and cerebrovascular diseases (Erfurth & Hagmar 2005;Krzyzanowska et al 2005;Bülow et al 1997).…”

Section: Introductionmentioning

confidence: 99%

Effects of Short-Term Nocturnal Cortisol Replacement on Cognitive Function and Quality of Life in Patients with Primary or Secondary Adrenal Insufficiency: A Pilot Study

Harbeck

Kropp

Mönig

2009

Appl Psychophysiol Biofeedback

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Cortisol replacement in patients with adrenal insufficiency usually consists of hydrocortisone (HC) given orally during day time. Due to the short half-life of hydrocortisone, cortisol levels between midnight and early morning are very low in contrast to the physiological rise of cortisol serum levels during this time. We investigated whether short-term cortisol replacement during the night improves cognitive function and well-being in these patients. Fourteen patients with adrenal insufficiency were put on HC infusion between midnight and 8 a.m. They subsequently underwent neurocognitive testing to measure intellectual functioning, concentration, memory and fine motor skills. Quality of life and mood were also evaluated. All tests were repeated after 2-4 weeks during usual oral glucocorticoid replacement therapy. Blood samples were taken for cortisol, epinephrine and norepinephrine measurement. With the exception of the digit symbol test with better scoring in the oral group (p = 0.005) there were no significant differences in neurocognitive testing, vegetative functions and quality of life on the two occasions. However, a higher cortisol level was associated with a worse performance in short-term memory. Plasma epinephrine concentration was subnormal in both groups, but increased only after intravenous hydrocortisone replacement. Mimicking the physiological rise in cortisol secretion during the night in this pilot study did neither significantly affect quality of life nor cognitive performance and vegetative functions. There was no improvement in general well being. Hydrocortisone infusion during night time might improve adrenomedullary reserve in patients with adrenal insufficiency.

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Section: Introductionmentioning

confidence: 99%

Effects of Short-Term Nocturnal Cortisol Replacement on Cognitive Function and Quality of Life in Patients with Primary or Secondary Adrenal Insufficiency: A Pilot Study

Harbeck

Kropp

Mönig

2009

Appl Psychophysiol Biofeedback

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“…Outpatient assessment of the HPA is hampered by ‘replacement’ glucocorticoid, 2 which in our experience can lead to unnecessary glucocorticoid exposure for months and even years following TSA. Such treatment causes adrenal suppression and is associated with altered bone turnover, osteoporosis, raised intraocular pressure, dysglycaemia and dyslipidaemia 7–9 …”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of a protocol for reduced glucocorticoid replacement in transsphenoidal pituitary adenomectomy: prophylactic glucocorticoid replacement is seldom necessary

Wentworth¹,

Gao

Sumithran³

et al. 2007

Clinical Endocrinology

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“…Endogenous cortisol production, determined by stable isotope dilution mass spectrometry in healthy individuals, is 6–11 mg/m 2 per day [20], but the ideal hydrocortisone replacement dose remains unclear. Recommended doses vary from 30 mg of hydrocortisone to as little as 12.5 mg per day, divided in two or three daily doses [21], [22]. In general, clinicians dose hydrocortisone empirically and average doses may vary substantially between different centres or physicians.…”

Section: Discussionmentioning

confidence: 99%

9β Polymorphism of the Glucocorticoid Receptor Gene Appears to Have Limited Impact in Patients with Addison’s Disease

et al. 2014

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BackgroundAddison’s disease (AD) has been associated with an increased risk of cardiovascular disease. Glucocorticoid receptor polymorphisms that alter glucocorticoid sensitivity may influence metabolic and cardiovascular risk factors in patients with AD. The 9β polymorphism of the glucocorticoid receptor gene is associated with relative glucocorticoid resistance and has been reported to increase the risk of myocardial infarction in the elderly. We explored the impact of this polymorphism in patients with AD.Materials and Methods147 patients with AD and 147 age, gender and ethnicity matched healthy controls were recruited. Blood was taken in a non-fasted state for plasma lipid determination, measurement of cardiovascular risk factors and DNA extraction.ResultsGenotype data for the 9β polymorphism was available for 139 patients and 146 controls. AD patients had a more atherogenic lipid profile characterized by an increase in the prevalence of small dense LDL (p = 0.003), increased triglycerides (p = 0.002), reduced HDLC (p<0.001) an elevated highly sensitive C-reactive protein (p = 0.01), compared with controls. The 9β polymorphism (at least one G allele) was found in 28% of patients and controls respectively. After adjusting for age, gender, ethnicity, BMI and hydrocortisone dose per metre square of body surface area in patients, there were no significant metabolic associations with this polymorphism and hydrocortisone doses were not higher in patients with the polymorphism.ConclusionsThis study did not identify any associations between the 9β polymorphism and cardiovascular risk factors or hydrocortisone dose and determination of this polymorphism is therefore unlikely to be of clinical benefit in the management of patients with AD.

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Hydrocortisone replacement dosage influences intraocular pressure in patients with primary and secondary hypocortisolism

Cited by 16 publications

References 40 publications

Effects of Short-Term Nocturnal Cortisol Replacement on Cognitive Function and Quality of Life in Patients with Primary or Secondary Adrenal Insufficiency: A Pilot Study

Effects of Short-Term Nocturnal Cortisol Replacement on Cognitive Function and Quality of Life in Patients with Primary or Secondary Adrenal Insufficiency: A Pilot Study

Prospective evaluation of a protocol for reduced glucocorticoid replacement in transsphenoidal pituitary adenomectomy: prophylactic glucocorticoid replacement is seldom necessary

9β Polymorphism of the Glucocorticoid Receptor Gene Appears to Have Limited Impact in Patients with Addison’s Disease

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