[Modified-release hydrocortisone for glucocorticoid deficiency].
Modified-release-Hydrocortison bei Glukokortikoidmangel.
Adrenal Insufficiency
/ drug therapy
Aged
Circadian Rhythm
/ physiology
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Dosage Calculations
Glucocorticoids
/ administration & dosage
Hormone Replacement Therapy
/ methods
Humans
Hydrocortisone
/ administration & dosage
Quality of Life
Treatment Outcome
Adrenal insufficiency
Aged
Circadian clocks
Circadian rhythm
Modified-release preparations
Journal
Der Internist
ISSN: 1432-1289
Titre abrégé: Internist (Berl)
Pays: Germany
ID NLM: 0264620
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
pubmed:
13
5
2020
medline:
5
8
2020
entrez:
13
5
2020
Statut:
ppublish
Résumé
The central circadian pacemaker in the suprachiasmatic nucleus and interaction of clock genes with the hypothalamus pituitary adrenal axis are responsible for very distinct cortisol concentrations. Unphysiologically high doses of glucocorticoids that do not follow the circadian rhythm lead to increased rates of morbidity, mortality and reduced quality of life. Does a switch to modified-release hydrocortisone in multimorbid elderly patients offer benefits compared to a conventional therapy regime? Evaluation, analysis and discussion of statistics, recent research results and expert advice. Overdosage and unphysiological timing of cortisol administration result in higher incidences of obesity, hypertension, hyperglycemia, coronary heart disease and cardiac events. Body weight, body mass index and HbA1c decline with Plenadren® (Shire Pharmaceuticals Ireland Limited, Dublin, Ireland) treatment compared to conventional therapy. CD16+ natural killer cells and natural killer cytotoxycity are reduced, and the incidence of respiratory-tract infections is increased, with conventional therapy compared to Plenadren®. Cortisol influences sleep pattern and sleep quality by its circadian secretion. Novel modified-release hydrocortisone preparations offer diverse benefits with regard to their effect on metabolism, cardiovascular risk, immunity and sleep, which might be beneficial in particular in multimorbid elderly.
Sections du résumé
BACKGROUND
BACKGROUND
The central circadian pacemaker in the suprachiasmatic nucleus and interaction of clock genes with the hypothalamus pituitary adrenal axis are responsible for very distinct cortisol concentrations. Unphysiologically high doses of glucocorticoids that do not follow the circadian rhythm lead to increased rates of morbidity, mortality and reduced quality of life.
OBJECTIVES
OBJECTIVE
Does a switch to modified-release hydrocortisone in multimorbid elderly patients offer benefits compared to a conventional therapy regime?
METHODS
METHODS
Evaluation, analysis and discussion of statistics, recent research results and expert advice.
RESULTS
RESULTS
Overdosage and unphysiological timing of cortisol administration result in higher incidences of obesity, hypertension, hyperglycemia, coronary heart disease and cardiac events. Body weight, body mass index and HbA1c decline with Plenadren® (Shire Pharmaceuticals Ireland Limited, Dublin, Ireland) treatment compared to conventional therapy. CD16+ natural killer cells and natural killer cytotoxycity are reduced, and the incidence of respiratory-tract infections is increased, with conventional therapy compared to Plenadren®. Cortisol influences sleep pattern and sleep quality by its circadian secretion.
CONCLUSION
CONCLUSIONS
Novel modified-release hydrocortisone preparations offer diverse benefits with regard to their effect on metabolism, cardiovascular risk, immunity and sleep, which might be beneficial in particular in multimorbid elderly.
Identifiants
pubmed: 32394073
doi: 10.1007/s00108-020-00795-z
pii: 10.1007/s00108-020-00795-z
doi:
Substances chimiques
Glucocorticoids
0
Hydrocortisone
WI4X0X7BPJ
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM