What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study.
Adrenal Insufficiency
/ diagnosis
Body Weight
Cortisone
/ administration & dosage
Dose-Response Relationship, Drug
Drug Dosage Calculations
Female
Fludrocortisone
/ administration & dosage
Follow-Up Studies
Glucocorticoids
/ administration & dosage
Hormone Replacement Therapy
/ methods
Humans
Italy
/ epidemiology
Male
Middle Aged
Patient Care Management
/ methods
Retrospective Studies
Risk Adjustment
/ methods
Risk Assessment
Sex Factors
Addison
Fludrocortisone
Hydrocortisone
Hypoadrenalism
Management
Journal
Journal of endocrinological investigation
ISSN: 1720-8386
Titre abrégé: J Endocrinol Invest
Pays: Italy
ID NLM: 7806594
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
16
06
2020
accepted:
02
08
2020
pubmed:
12
8
2020
medline:
6
11
2021
entrez:
12
8
2020
Statut:
ppublish
Résumé
The impact of patient's characteristics on glucocorticoid (GC) replacement therapy in adrenal insufficiency (AI) is poorly evaluated. Aims of this study were to assess the influence of sex and body weight on GC dosing and to describe the choice of GC in AI of different etiologies. We retrospectively evaluated hydrocortisone (HC) equivalent total daily dose (HC-TDD) and per-kg-daily dose (HC-KDD) in 203 patients (104 primary AI [pAI], 99 secondary AI [sAI]) followed up for ≥ 12 months. They were treated with HC, modified-release HC (MRHC) or cortisone acetate (CA) and fludrocortisone acetate (FCA) in pAI. At baseline, CA was preferred both in pAI and sAI; at last visit, MRHC was most used in pAI (49%) and CA in sAI (73.7%). Comparing the last visit with baseline, in pAI, HC-TDD and HC-KDD were significantly lower (p = 0.04 and p = 0.006, respectively), while FCA doses increased during follow-up (p = 0.02). The reduction of HC-TDD and HC-KDD was particularly relevant for pAI women (p = 0.04 and p = 0.002, respectively). In sAI patients, no change of HC-KDD and HC-TDD was observed, and we found a correlation between weight and HC-TDD in males (r 0.35, p = 0.02). Our real-life study demonstrated the influence of etiology of AI on the type of GC used, a weight-based tailoring in sAI, a likely overdosage of GC treatment in pAI women at the start of treatment and the possibility to successfully increase FCA avoiding GC over-treatment. These observations could inform the usual clinical practice.
Identifiants
pubmed: 32779106
doi: 10.1007/s40618-020-01386-3
pii: 10.1007/s40618-020-01386-3
pmc: PMC7946659
doi:
Substances chimiques
Glucocorticoids
0
Fludrocortisone
U0476M545B
Cortisone
V27W9254FZ
fludrocortisone acetate
V47IF0PVH4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
865-872Subventions
Organisme : Fondi per la Ricerca Locale Università di Torino 2018
ID : RILO 2018
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