scholarly journals Continuous subcutaneous hydrocortisone infusion in Addison’s disease

2007 ◽  
Vol 157 (1) ◽  
pp. 109-112 ◽  
Author(s):  
Kristian Løvås ◽  
Eystein S Husebye
Keyword(s):  
Replacement Therapy ◽  
Salivary Cortisol ◽  
Short Form ◽  
Circadian Variation ◽  
Addison’S Disease ◽  
Subjective Health ◽  
Addison's Disease ◽  
Subjective Health Status ◽  
Daily Dose ◽  
Design And Methods

Objective: The conventional replacement therapy in Addison’s disease (AD) does not restore the normal diurnal cortisol rhythm. We explored the feasibility and safety of continuous s.c. hydrocortisone infusion (CSHI) as a novel mode of glucocorticoid replacement therapy. Design and methods: Seven patients with AD were treated with CSHI in an open-labelled clinical study for up to three months. Adequacy of glucocorticoid replacement was assessed by 24 h blood and saliva sampling in one patient and by salivary cortisol day curves in six outpatients. Subjective health status was monitored by the Short Form-36 questionnaire. Results: CSHI re-established the circadian variation and normal levels of cortisol in the patients, with minor day-to-day variation. Most of the patients could reduce their glucocorticoid dose considerably without adverse reactions. The treatment was well tolerated and positively evaluated by the patients. Conclusions: CSHI is technically feasible and safe in patients with AD. A daily dose of ~10 mg/m2 body surface area/day restores the circadian variation and normal levels of salivary cortisol in most patients, which is close to the estimated daily requirement. We hypothesise that selected patients will benefit from restoration of the circadian cortisol rhythm.

scholarly journals Grapefruit juice and licorice increase cortisol availability in patients with Addison's disease

2011 ◽  
Vol 165 (5) ◽  
pp. 761-769 ◽  
Author(s):  
Paal Methlie ◽  
Eystein E S Husebye ◽  
Steinar Hustad ◽  
Ernst A Lien ◽  
Kristian Løvås
Keyword(s):  
Grapefruit Juice ◽  
Area Under The Curve ◽  
Addison’S Disease ◽  
Serum Cortisol ◽  
Subjective Health ◽  
University Hospital ◽  
Addison's Disease ◽  
Subjective Health Status ◽  
The Hours ◽  
The Impact

ObjectiveFailure to mirror the diurnal cortisol profile could contribute to the impaired subjective health status in Addison's disease (AD). Some patients report benefit from the use of various nutritional compounds. The objective of this study was to investigate the impact of licorice and grapefruit juice (GFJ) on the absorption and metabolism of cortisone acetate (CA).DesignPatients (n=17) with AD on stable CA replacement therapy were recruited from the outpatient clinic at Haukeland University Hospital, Norway. They were assessed on their ordinary CA medication and following two 3-day periods of co-administration of licorice or GFJ.MethodsTime series of glucocorticoids (GCs) in serum and saliva were obtained, and GCs in 24 h urine samples were determined. The main outcome measure was the area under the curve (AUC) for serum cortisol in the first 2.6 h after orally administered CA.ResultsCompared with the ordinary treatment, the median AUC for serum cortisol increased with licorice (53 783 vs 50 882, P<0.05) and GFJ (60 661 vs 50 882, P<0.05). Median cortisol levels in serum were also elevated 2.6 h after tablet ingestion (licorice 223 vs 186 nmol/l, P<0.05; GFJ 337 vs 186 nmol/l, P<0.01). Licorice increased the median urinary cortisol/cortisone ratio (0.43 vs 0.21, P<0.00001), whereas GFJ increased the (allo-tetrahydrocortisol+tetrahydrocortisol)/tetrahydrocortisone ratio (0.55 vs 0.43, P<0.05).ConclusionLicorice and in particular GFJ increased cortisol available to tissues in the hours following oral CA administration. Both patients and physicians should be aware of these interactions.

Salivary Cortisol day curves in assessing glucocorticoid replacement therapy in Addison’s disease

HORMONES ◽  
2013 ◽  
Vol 12 (1) ◽  
pp. 93-100 ◽  
Author(s):  
Lisanne Smans ◽  
Eef Lentjes ◽  
Ad Hermus ◽  
Pierre Zelissen
Keyword(s):  
Replacement Therapy ◽  
Salivary Cortisol ◽  
Addison’S Disease ◽  
Addison's Disease ◽  
Glucocorticoid Replacement Therapy

Subjective health status in Norwegian patients with Addison’s disease*

2002 ◽  
Vol 56 (5) ◽  
pp. 581-588 ◽  
Author(s):  
Kristian Løvås ◽  
Jon Håvard Loge ◽  
Eystein S. Husebye
Keyword(s):  
Health Status ◽  
Addison’S Disease ◽  
Subjective Health ◽  
Addison's Disease ◽  
Subjective Health Status

scholarly journals Impaired subjective health status in chronic adrenal insufficiency: impact of different glucocorticoid replacement regimens

2008 ◽  
Vol 159 (6) ◽  
pp. 811-817 ◽  
Author(s):  
Benjamin Bleicken ◽  
Stefanie Hahner ◽  
Melanie Loeffler ◽  
Manfred Ventz ◽  
Bruno Allolio ◽  
...  
Keyword(s):  
Health Status ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Short Form ◽  
Bodily Pain ◽  
Depression Scale ◽  
Well Being ◽  
Subjective Health ◽  
Subjective Health Status ◽  
Sf 36

ContextRecent studies have suggested that current glucocorticoid replacement therapies fail to fully restore well-being in patients with adrenal insufficiency (AI).ObjectiveTo investigate the effect of different glucocorticoid preparations used for replacement therapy on subjective health status (SHS) in AI.Design and patientsIn a cross-sectional study, primary and secondary AI patients were contacted by mail. Individual glucocorticoid replacement regimens, underlying diagnoses and comorbidities were verified by questionnaires and review of medical records. Patients were asked to complete three validated self-assessment questionnaires (Short Form 36 (SF-36), Giessen Complaint List (GBB-24), and Hospital Anxiety and Depression Scale). Results were compared with sex- and age-matched controls drawn from the questionnaire-specific reference cohort.ResultsOf the 883 patients identified, 526 agreed to participate in the study. Completed questionnaire sets were available from 427 patients (primary AI n=232; secondary AI n=195). AI patients showed significantly impaired SHS compared with controls irrespective of the glucocorticoid used for replacement. The only difference in SHS between patients on prednisolone (PR) and hydrocortisone (all patients and sub-analysis for primary AI) was significant higher bodily pain (lower Z-score in SF-36) in patients on PR (P<0.05, P<0.01 respectively). In patients with secondary AI, the PR group showed significantly (P<0.05) less heart complaints (lower Z-score) in the GBB questionnaire compared with the cortisone acetate group.ConclusionsGlucocorticoid replacement therapy with PR seems to be equivalent to hydrocortisone regarding SHS in patients with AI. However, SHS remains impaired in all patient groups suggesting a need for further improved glucocorticoid replacement strategies.

Oral dehydroepiandrosterone (DHEA) replacement therapy in women with Addison's disease

2000 ◽  
Vol 52 (6) ◽  
pp. 775-780 ◽  
Author(s):  
Gennet Gebre-Medhin ◽  
Eystein S. Husebye ◽  
Hans Mallmin ◽  
Lotti Helström ◽  
Christian Berne ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Addison’S Disease ◽  
Addison's Disease

Salivary Cortisol and Cortisone do not Appear to be Useful Biomarkers for Monitoring Hydrocortisone Replacement in Addison’s Disease

2016 ◽  
Vol 48 (12) ◽  
pp. 814-821 ◽  
Author(s):  
I. Ross ◽  
M. Lacerda ◽  
T. Pillay ◽  
D. Blom ◽  
G. Johannsson ◽  
...  
Keyword(s):  
Salivary Cortisol ◽  
Addison’S Disease ◽  
Addison's Disease

scholarly journals Treatment of Addison’s disease during pregnancy

2018 ◽  
Vol 2018 ◽  
Author(s):  
Diana Oliveira ◽  
Adriana Lages ◽  
Sandra Paiva ◽  
Francisco Carrilho
Keyword(s):  
Patient Education ◽  
Replacement Therapy ◽  
Addison’S Disease ◽  
Pregnant Patient ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Adrenal Crisis ◽  
Multidisciplinary Teams ◽  
Addison's Disease ◽  
List Type

Summary Addison’s disease, or primary adrenocortical insufficiency, is a long-term, potentially severe, rare endocrine disorder. In pregnancy, it is even rarer. We report the case of a 30-year-old pregnant patient with Addison’s disease, referred to Obstetrics-Endocrinology specialty consult at 14 weeks gestation. She had been to the emergency department of her local hospital various times during the first trimester presenting with a clinical scenario suggestive of glucocorticoid under-replacement (nausea, persistent vomiting and hypotension), but this was interpreted as normal pregnancy symptoms. Hydrocortisone dose was adjusted, and the patient maintained regular follow-up. No complications were reported for the remainder of gestation and delivery. Pregnant patients with Addison’s disease should be monitored during gestation and in the peripartum period by multidisciplinary teams. Adjustments in glucocorticoid and mineralocorticoid replacement therapy are often necessary, and monitoring should be based mainly on clinical findings, which becomes increasingly difficult during pregnancy. Patient education and specialized monitoring are key to avoiding complications from under- or over-replacement therapy in this period. Learning points: An increase in glucocorticoid replacement dose is expected to be necessary during pregnancy in a woman with Addison’s disease. Patient education regarding steroid cover and symptoms of acute adrenal crisis are fundamental. Monitoring in this period is challenging and remains mainly clinical. The increase in hydrocortisone dose often obviates the need to increase fludrocortisone dose.

scholarly journals Regression of cardiac abnormalities after replacement therapy in Addison's disease

1999 ◽  
pp. 425-428 ◽  
Author(s):  
F Fallo ◽  
C Betterle ◽  
S Budano ◽  
M Lupia ◽  
M Boscaro ◽  
...  
Keyword(s):  
Addison’S Disease ◽  
Left Ventricular ◽  
Addison's Disease ◽  
Cardiac Abnormalities ◽  
Left Ventricular Chamber ◽  
Before And After ◽  
Echocardiographic Parameters ◽  
Spectral Doppler ◽  
And Function ◽  
Design And Methods

OBJECTIVE: To evaluate by echocardiography the cardiac structure and function in patients with primary adrenocortical insufficiency. DESIGN AND METHODS: Two-dimensionally guided M-mode echocardiograms and spectral Doppler studies were performed in seven consecutive patients with newly diagnosed autoimmune primary adrenal failure before and 4-8 months after an adequate regimen of steroid substitution. Echocardiographic parameters were also studied in ten healthy controls. RESULTS: In the cases with untreated Addison's disease, both left ventricular end-systolic and end-diastolic dimensions were significantly reduced in comparison with those in controls (P<0.01). Four patients had echocardiographic signs of mitral valve prolapse (MVP) at the anterior leaflet, with no evidence of mitral regurgitation by Doppler echocardiography. Systolic clicks characteristic of MVP were present on auscultation in two of these cases. Left ventricular chamber size normalized, i.e. significantly increased (P<0.01), and both echocardiographic and physical signs of MVP resolved after steroid substitution in all patients. All other echocardiographic indices were normal before and after treatment. CONCLUSIONS: Patients with untreated Addison's disease have cardiac abnormalities which regress after steroid substitution. A valvular-ventricular disproportion due to the hypovolemic state could explain these findings.

Sign in / Sign up

Export Citation Format

Share Document