THE EFFECT OF o,p'‐DDD ON ADRENAL STEROID REPLACEMENT THERAPY REQUIREMENTS

Robinson, Bruce G.; Hales, I. B.; Henniker, Anthony; Ho, K. Y.; Luttrell, Brian; Smee, I. R.; Stiel, J. N.

doi:10.1111/j.1365-2265.1987.tb01171.x

Cited by 57 publications

(30 citation statements)

References 11 publications

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“…Hypoadrenalism can occur with normal replacement doses (66,146,147). The metabolism of dexamethasone is particularly affected and should be avoided in these patients.…”

Section: Dosingmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Steroidogenesis enzyme inhibitors in Cushing's syndrome

Daniel

Newell‐Price

2015

European Journal of Endocrinology

111

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Steroidogenesis enzyme inhibitors are the mainstay of medical therapy in Cushing's syndrome (CS). Ketoconazole (KTZ) and metyrapone are the most commonly used agents. Although there is considerable experience of their use in individual specialist centres, these drugs have not been rigorously tested in prospective clinical trials. Clinicians face uncertainties and concerns with respect to the safety profile of these agents, and best means to monitor effect. We review steroidogenesis inhibitors in the management of CS, including older agents (KTZ, metyrapone, etomidate and mitotane) and those currently under development (LCI699, non-racemic KTZ), and offer a practical approach for their use in clinical practice.

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“…Hypoadrenalism can occur with normal replacement doses (66,146,147). The metabolism of dexamethasone is particularly affected and should be avoided in these patients.…”

Section: Dosingmentioning

confidence: 99%

THERAPY OF ENDOCRINE DISEASE: Steroidogenesis enzyme inhibitors in Cushing's syndrome

Daniel

Newell‐Price

2015

European Journal of Endocrinology

111

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“…*It is sometimes necessary to increase the GC replacement dose when mitotane is prescribed because of its enhancing effect on cortisol binding globulin (CBG) [19,20].…”

Section: I-26mentioning

confidence: 99%

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

et al. 2016

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Abstract. This clinical practice guideline of the diagnosis and treatment of adrenal insufficiency (AI) including adrenal crisis was produced on behalf of the Japan Endocrine Society. This evidence-based guideline was developed by a committee including all authors, and was reviewed by a subcommittee of the Japan Endocrine Society. The Japanese version has already been published, and the essential points have been summarized in this English language version. We recommend diagnostic tests, including measurement of basal cortisol and ACTH levels in combination with a rapid ACTH (250 µg corticotropin) test, the CRH test, and for particular situations the insulin tolerance test. Cut-off values in basal and peak cortisol levels after the rapid ACTH or CRH tests are proposed based on the assumption that a peak cortisol level ≥18 µg/ dL in the insulin tolerance test indicates normal adrenal function. In adult AI patients, 15-25 mg hydrocortisone (HC) in 2-3 daily doses, depending on adrenal reserve and body weight, is a basic replacement regime for AI. In special situations such as sickness, operations, pregnancy and drug interactions, cautious HC dosing or the correct choice of glucocorticoids is necessary. From long-term treatment, optimal diurnal rhythm and concentration of serum cortisol are important for the prevention of cardiovascular disease and osteoporosis. In maintenance therapy during the growth period of patients with 21-hydroxylase deficiency, proper doses of HC should be used, and long-acting glucocorticoids should not be used. Education and carrying an emergency card are essential for the prevention and rapid treatment of adrenal crisis.Key words: Adrenal insufficiency, Adrenal crisis, Cortisol, Hydrocortisone, Congenital adrenal hyperplasia Summary of Recommendations I. Chronic adrenal insufficiency (AI) I-1.0 SymptomsWe recommend suspecting AI in patients who have the following symptoms.

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“…Several medical treatments have been proposed in CD: despite its effectiveness, mitotane therapy is complicated by several side effects (11)(12)(13); metyrapone, which was mainly used in combination with aminoglutethimide, frequently induces hyperandrogenism (14,15); only a small percentage of patients with CD is in remission with bromocriptine (15); and efficacy of glitazones is still a matter of debate with contradictory results in previously published series (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Ketoconazole revisited: a preoperative or postoperative treatment in Cushing's disease

Castinetti¹,

Morange²,

Jaquet³

et al. 2008

European Journal of Endocrinology

163

122

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Context: Although transsphenoidal surgery remains the first-line treatment in Cushing's disease (CD), recurrence is observed in about 20% of cases. Adjunctive treatments each have specific drawbacks. Despite its inhibitory effects on steroidogenesis, the antifungal drug ketoconazole was only evaluated in series with few patients and/or short-term follow-up. Objective: Analysis of long-term hormonal effects and tolerance of ketoconazole in CD. Design: A total of 38 patients were retrospectively studied with a mean follow-up of 23 months (6-72). Setting: All patients were treated at the same Department of Endocrinology in Marseille, France. Patients: The 38 patients with CD, of whom 17 had previous transsphenoidal surgery. Intervention: Ketoconazole was begun at 200-400 mg/day and titrated up to 1200 mg/day until biochemical remission. Main outcome measures: Patients were considered controlled if 24-h urinary free cortisol was normalized. Results: Five patients stopped ketoconazole during the first week because of clinical or biological intolerance. On an intention to treat basis, 45% of the patients were controlled as were 51% of those treated long term. Initial hormonal levels were not statistically different between patients controlled or uncontrolled. Ketoconazole was similarly efficacious as a primary or postoperative treatment. Among 15 patients without visible adenoma at initial evaluation, subsequent follow-up allowed identification of the lesion in five cases. No adrenal insufficiency was observed. Adverse effects were rare in patients treated long term. Conclusions: Ketoconazole is a safe and efficacious treatment in CD, particularly in patients for whom surgery is contraindicated, or delayed because of the absence of image of adenoma on magnetic resonance imaging.European Journal of Endocrinology 158 91-99

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THE EFFECT OF o,p'‐DDD ON ADRENAL STEROID REPLACEMENT THERAPY REQUIREMENTS

Cited by 57 publications

References 11 publications

THERAPY OF ENDOCRINE DISEASE: Steroidogenesis enzyme inhibitors in Cushing's syndrome

THERAPY OF ENDOCRINE DISEASE: Steroidogenesis enzyme inhibitors in Cushing's syndrome

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

Ketoconazole revisited: a preoperative or postoperative treatment in Cushing's disease

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