scholarly journals Switching From Immediate-Release to Fractionated Dual-Release Hydrocortisone May Improve Metabolic Control and QoL in Selected Primary Adrenal Insufficiency Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Francesca Delle Cese ◽  
Andrea Corsello ◽  
Marco Cintoni ◽  
Pietro Locantore ◽  
Alfredo Pontecorvi ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Adrenal Insufficiency ◽  
Metabolic Control ◽  
Immediate Release ◽  
Metabolic Parameters ◽  
Primary Adrenal Insufficiency ◽  
Once Daily ◽  
Group A ◽  
Dual Release ◽  
Group B

ObjectiveThe use of once-daily dual-release HC (DR-HC) in primary adrenal insufficiency (PAI) is often associated with benefits in metabolic parameters when compared to immediate-release HC (IR-HC). In this study, we evaluated the effects on clinical, biochemical and metabolic parameters of switching from IR-HC to lower-dose DR-HC given both in once and fractionated daily doses.MethodsTwenty autoimmune-PAI subjects were included. Patients on 30 mg/day divided in three doses IR-HC regimen (group A) were switched to DR-HC 25 mg/day given in two daily doses (20 mg in the morning and 5 mg at 2.00 p.m.); patients on 25 mg/day divided in two doses IR-HC regimen (group B) were switched to DR-HC 20 mg once daily. Biochemical and metabolic parameters, BMI and quality of life (QoL) were evaluated at the baseline and six months after the switch.ResultsOur small non-randomized study with short follow up showed significant benefits in both group A and group B without any apparent side-effects. After the switch to DR-HC, a significant decrease in adrenocorticotropic hormone (ACTH), HbA1c, total cholesterol, triglycerides, LDL, cholesterol, BMI as well as a significant improvement in QoL, were observed in both groups. At 6 months, ACTH levels were lower in group A while HbA1C and total cholesterol were lower in group B.ConclusionThe DR-HC is a valid and effective therapeutic strategy to improve the metabolic control and the QoL in PAI. The reduction of ACTH levels with DR-HC regimens reflects a better biochemical control of PAI, obtained by using a lower dose and more physiological HC formulation. Both once-daily and fractionated daily doses of DR-HC showed advantages compared with IR-HC formulation.

scholarly journals Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency

2019 ◽  
Vol 8 (7) ◽  
pp. 853-862 ◽  
Author(s):  
V Guarnotta ◽  
C Di Stefano ◽  
A Santoro ◽  
A Ciresi ◽  
A Coppola ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Waist Circumference ◽  
Adrenal Insufficiency ◽  
Ldl Cholesterol ◽  
Metabolic Parameters ◽  
Metabolic Effects ◽  
Low Doses ◽  
Group A ◽  
Dual Release ◽  
Group B

Background Dual-release hydrocortisone (DR-HC) improves metabolism in patients with adrenal insufficiency. The aims of this study were to compare the cardiovascular and metabolic effects of conventional glucocorticoids (GCs) vs. DR-HC and of high vs. low doses of GCs, after 48 months of observation. Methods We selected 27 patients on hydrocortisone (mean dose 17.5 ± 4.2 mg/day) and 20 patients on cortisone acetate (mean dose 37.5 ± 12.1 mg/day) who maintained this treatment (group A) and 53 patients switched to DR-HC (mean dose 22 ± 4.8 mg/day) (group B). At baseline and after 48 months, clinical and metabolic parameters and Framingham Risk Score (FRS) were obtained. Results After 48 months, patients in group A had a significant increase from baseline in BMI (P < 0.001), waist circumference (P = 0.001), systolic blood pressure (P = 0.001), LDL cholesterol (P = 0.018), HbA1c (P = 0.020) and FRS (P = 0.002). By contrast, patients in group B had a significant decrease in BMI (P = 0.002), waist circumference (P = 0.015), diastolic blood pressure (P = 0.031), total (P = 0.006) and LDL cholesterol (P = 0.005), HbA1c (P < 0.001) and FRS (P = 0.015) compared to baseline. No significant differences between high and low doses of both conventional GCs and DR-HC were observed. Conclusions DR-HC is associated with an improvement of metabolic parameters and cardiovascular risk compared to conventional GCs, which are associated with a worsening of these parameters, regardless of the dose used.

scholarly journals Long-Term Outcomes of Conventional And Novel Steroid Replacement Therapy On Bone Health In Primary Adrenal Insufficiency

2021 ◽  
Author(s):  
Valentina Guarnotta ◽  
Claudia Di Stefano ◽  
Carla Giordano
Keyword(s):  
Alkaline Phosphatase ◽  
Lumbar Spine ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Bone Alkaline Phosphatase ◽  
Primary Adrenal Insufficiency ◽  
Z Scores ◽  
Group A ◽  
Group B

Abstract Purpose: To compare dual-release hydrocortisone (DR-HC) and conventional glucocorticoids (GCs) on bone metabolism in patients with primary adrenal insufficiency (PAI).Methods: Thirty-five patients with PAI maintained conventional GCs (group A), while other 35 were switched to DR-HC (group B). At baseline and after 18, 36 and 60 months of conventional GCs and DR-HC treatment, the clinical and bone metabolic parameters were evaluated. Results: After 60 months of follow-up, patients in group A had a significant increase in Body Mass Index (BMI) (p=0.004) and Waist Circumference (WC) (p=0.026) and a significant decrease in osteocalcin (p=0.002), bone alkaline phosphatase (p=0.029), lumbar spine bone mass density (BMD) T and Z scores (p<0.001 and p=0.001, respectively) than baseline. By contrast, patients in group B had a significant decrease in WC (p=0.047) and increase in bone alkaline phosphatase (p=0.019), lumbar spine BMD T score (p=0.032), femoral neck BMD T and Z scores (p=0.023 and p=0.036, respectively) than baseline. Conclusions: Long-term conventional steroid replacement therapy is associated with a decrease in BMD, notably at lumbar spine, and an increase in vertebral fractures rate. By contrast, DR-HC treatment is associated with improvement of BMD.

scholarly journals Monitoring effects of atenolol versus olmesartan medoxomil on metabolic parameters

2018 ◽  
Vol 7 (9) ◽  
pp. 1837
Author(s):  
Ranjodh Jeet Singh ◽  
Kanika Kohli ◽  
Parveen Gupta ◽  
Ashwani Kumar Gupta
Keyword(s):  
Lipid Profile ◽  
Total Cholesterol ◽  
Beta Blocker ◽  
Olmesartan Medoxomil ◽  
Baseline Period ◽  
Metabolic Parameters ◽  
Group A ◽  
Group B ◽  
Stage 1 ◽  
To Receive

Background: The increase in CVS morbidity and mortality could be significantly reduced by control of SBP and DBP, as well as reduction in Hyperlipidemia.Methods: The patients of stage-1 HTN with either sex according to JNC VII criteria were included and were followed up every 2 weeks from baseline upto 12 weeks. The randomized patients were divided into two groups to receive beta blocker viz. Atenolol 50 mg (group A, N=50) and ARB Olmesartan medoxomil 40 mg (group B, N=50).Results: The average Total cholesterol measured among Group A subjects was significantly increased by 1.8% by the end of 12th week whereas the average cholesterol measured among Group B subjects at baseline period was reduced by 7.9% after 12 weeks therapy. The average HDL measured among Group A subjects at baseline period significantly reduces by 5.9% by the end of 12th week whereas the HDL levels measured among Group B subjects at baseline period was significantly increased by after 12 weeks therapy. The average Triglyceride (TG) levels measured among Group A subjects at baseline period was significantly increased by 12.4% by the end of 12th week whereas the Triglyceride (TG) levels measured among Group B subjects at baseline period was significantly reduced by 9.5% after 12 weeks therapy. The average LDL levels measured among Group A subjects at baseline period was significantly increased by 1.5% by the end of 12thweek whereas the average LDL measured among Group B subjects at baseline period was significantly reduced by 11.2% to after 12 weeks therapy. The average VLDL levels measured among Group A subjects at baseline period was significantly increased by 12.4% by the end of 12th week whereas the average VLDL measured among Group B subjects at baseline period was significantly reduced by 9.5% after 12 weeks therapy.Conclusions: ARB- Olmesartan medoxomil is a better drug than beta blocker-Atenolol as it leads to greater deduction in lipid profile.

scholarly journals Effect of lactation on serum total cholesterol & triglyceride

2014 ◽  
Vol 29 (1-2) ◽  
pp. 1-7
Author(s):  
Khadiza Begum ◽  
Rokeya Begum ◽  
Qazi Shamima Akhter ◽  
Nusrat Sultana ◽  
Shamima Bari
Keyword(s):  
Total Cholesterol ◽  
Study Groups ◽  
Cross Sectional Study ◽  
Serum Total Cholesterol ◽  
Cross Sectional ◽  
Medical College ◽  
Data Collection Sheet ◽  
Group A ◽  
Group B ◽  
High Level

Background: There is an association between breast feeding & maternal lipid profile. Pregnancy related hyperlipidaemia reverse quickly with lactation. Objective: To observe Serum Total cholesterol & triglyceride in lactating & nonlactating mother. Method: The present cross sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka, during the period of July 2010 to June 2011. A total 300 subjects were included within the age limit from 20 to 40 years of women. Among them100 were normal healthy subjects & had child above 3 years were considered as group A (control). The rest 200 women were selected as study subject (group B) having child between the age 6 weeks to 2 years. Group B is again subdivided into group B1 (100 lactating mother) & group B2 (100 nonlactating mother). The subjects were selected from pediatric ward & OPD of pediatrics, DMCH and BSMMU, Dhaka. Data were collected in data collection sheet after taking informed written consent of the subjects. The study parameters total cholesterol & Triglyceride were done in the Department of Physiology, Dhaka Medical College. The data were analyzed by computer with SPSS programs using unpaired Student ?t’ test.Results: In group B1 total cholesterol & triglyceride levels were non significantly higher than that of group A but in group B2 these values were significantly higher than that of group A. Within the study groups all these values were significantly higher in nonlactating mother than lactating mother. It was observed that high level of study parameters were more in B2 than that of group B1. Conclusion: From the results of the present study it may be concluded that lactation has effect on lowering serum total cholesterol & triglyceride which may preferably related to health education for the mother. http://dx.doi.org/10.3329/bjpp.v29i1-2.20060Bangladesh J Physiol Pharmacol 2013; 29(1&2) : 1-7

High- Versus Standard-Dose Filgrastim (rhG-CSF) for Mobilization of Peripheral-Blood Progenitor Cells From Allogeneic Donors and CD34+ Immunoselection

1999 ◽  
Vol 17 (7) ◽  
pp. 2160-2160 ◽  
Author(s):  
Monika Engelhardt ◽  
Hartmut Bertz ◽  
Matthias Afting ◽  
Cornelius F. Waller ◽  
Jürgen Finke
Keyword(s):  
Progenitor Cells ◽  
Peripheral Blood ◽  
Standard Dose ◽  
Allogeneic Transplantation ◽  
Selection Procedures ◽  
Once Daily ◽  
Cell Numbers ◽  
Peripheral Blood Progenitor Cells ◽  
Group A ◽  
Group B

PURPOSE: The efficacy of a high- versus a standard-dose filgrastim (recombinant human granulocyte colony-stimulating factor, or rhG-CSF) regimen to mobilize peripheral-blood progenitor cells (PBPCs) for allogeneic transplantation was investigated in 75 healthy donors. PATIENTS AND METHODS: From December 1994 to December 1997, 75 consecutive donors (median age, 38 years; range, 17 to 67 years) were assigned to two different schedules of rhG-CSF for PBPC mobilization. Fifty donors received 24 μg rhG-CSF/kg body weight (BW) divided into two daily subcutaneous injections (two doses of 12 μg, group A), whereas 25 were treated with 10 μg rhG-CSF once daily (group B). Apheresis was started on day 4 in group A and on day 5 in group B. Target CD34+ cell numbers in apheresis products were ≥ 4 × 106/kg recipient BW. RESULTS: Cytokine priming and collection of PBPCs were equally well tolerated in both groups. Significantly higher CD34+ cell numbers in group A with 3.7 × 106/kg recipient BW/apheresis (0.47 × 106/L apheresis) compared with 2 × 106/kg recipient BW/apheresis (0.25 × 106/L apharesis) in group B were obtained (P < .05). Using standard aphereses (median, 9 L), two doses of 12 μg rhG-CSF/kg allowed collection of ≥ 4 × 106/kg CD34+ cells with two aphereses (range, one to three) in group A versus three aphereses (range, one to six) in group B (P < .015). Donor age, sex, and BW influenced the collection of CD34+ cell numbers: in particular, significantly higher apheresis results were obtained in donors younger than 40 years compared with donors older than 40 years of age (P < .05). In 65 CD34+ selection procedures using avidin-biotin immunoabsorption columns (Ceprate SC System, CellPro, Bothell, WA), a median CD34+ purity of 53%, CD34+ recovery of 40%, and the collection of 2 × 106/kg CD34+ cells/selection were achieved. In group A with higher CD34+ cells/kg/apheresis, CD34+ purity, recovery, and cell yields were 60%, 45%, and 2.3 × 106/kg/selection, respectively, as compared with 48%, 31%, and 0.7 × 106/kg in group B (P < .05). CONCLUSION: Our results demonstrate that twice daily rhG-CSF (two doses of 12 μg/kg BM) compared with once daily rhG-CSF (10 μg/kg BW), in addition to being well tolerated, significantly improves PBPC mobilization, allows the collection of higher numbers of CD34+ cells with one or two standard aphereses, and facilitates subsequent selection procedures in healthy allogeneic donors.

scholarly journals Prednisolone is associated with a worse bone mineral density in primary adrenal insufficiency

2018 ◽  
Vol 7 (6) ◽  
pp. 811-818 ◽  
Author(s):  
Kathrin R Frey ◽  
Tina Kienitz ◽  
Julia Schulz ◽  
Manfred Ventz ◽  
Kathrin Zopf ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Bone Mineral ◽  
Immediate Release ◽  
Modified Release ◽  
Mineral Density ◽  
Primary Adrenal Insufficiency ◽  
Z Scores

Context Patients with primary adrenal insufficiency (PAI) or congenital adrenal hyperplasia (CAH) receive life-long glucocorticoid (GC) therapy. Daily GC doses are often above the physiological cortisol production rate and can cause long-term morbidities such as osteoporosis. No prospective trial has investigated the long-term effect of different GC therapies on bone mineral density (BMD) in those patients. Objectives To determine if patients on hydrocortisone (HC) or prednisolone show changes in BMD after follow-up of 5.5 years. To investigate if BMD is altered after switching from immediate- to modified-release HC. Design and patients Prospective, observational, longitudinal study with evaluation of BMD by DXA at visit1, after 2.2 ± 0.4 (visit2) and after 5.5 ± 0.8 years (visit3) included 36 PAI and 8 CAH patients. Thirteen patients received prednisolone (age 52.5 ± 14.8 years; 8 women) and 31 patients received immediate-release HC (age 48.9 ± 15.8 years; 22 women). Twelve patients on immediate-release switched to modified-release HC at visit2. Results Prednisolone showed significantly lower Z-scores compared to HC at femoral neck (−0.85 ± 0.80 vs −0.25 ± 1.16, P < 0.05), trochanter (−0.96 ± 0.62 vs 0.51 ± 1.07, P < 0.05) and total hip (−0.78 ± 0.55 vs 0.36 ± 1.04, P < 0.05), but not at lumbar spine, throughout the study. Prednisolone dose decreased by 8% over study time, but no significant effect was seen on BMD. BMD did not change significantly after switching from immediate- to modified-release HC. Conclusions The use of prednisolone as hormone replacement therapy results in significantly lower BMD compared to HC. Patients on low-dose HC replacement therapy showed unchanged Z-scores within the normal reference range during the study period.

scholarly journals Role of Immediate Release and Delayed Release Omeprazole in Patients with Gastro Esophageal Reflux Disease

2017 ◽  
Vol 11 (2) ◽  
pp. 67-73
Author(s):  
Mahabub Rahman ◽  
Dewan Saifuddin Ahmed ◽  
Syeda Nur E Jannat ◽  
MM Shahin Ul Islam ◽  
Abu Ahmed Abdullah
Keyword(s):  
Reflux Disease ◽  
Immediate Release ◽  
Esophageal Reflux ◽  
Double Blind ◽  
Delayed Release ◽  
End Of Treatment ◽  
Significant Difference ◽  
Group A ◽  
Group B

Proton pump inhibitors are widely used for Gastro Esophageal Reflux Disease (GERD) treatment. This prospective double blind randomized cross over study was carried out in the Department of Gastroenterology, BSMMU from June 2007 to May 2008 to assess the efficacy of Immediate-release omeprazole (IR-OMEP) & Delayed-release Omeprazole (DR-OMEP) in relieving symptoms & healing of oesophagitis in GERD. All patients who fulfilled the inclusion criteria underwent upper gastrointestinal (UGI) endoscopy to be lebelled as nonerosive and erosive GERD. Among total 69 patients, 43 (62.3 %) had nonerosive and 26 (37.7 %) had erosive GERD. Patients were divided into group A (35) and group B (34) who received group A drugs (20 mg IR-OMEP bd) and group B drugs (20 mg DROMEP bd) from day 1-14 respectively. Then drugs were crossed over (group A: 20mg DR-OMEP bd; group B: 20 mg IR-OMEP bd) from day 15-28. Improvement of heartburn, regurgitation in each group were assessed in every week, during drug cross over and at the end and then compared between two groups. There was no significant difference in relieving heartburn and regurgitation between IR-OMEP and DR-OMEP either in erosive or nonerosive GERD (P>0.50). Patients with erosive GERD underwent UGI endoscopy at the end of treatment to see healing of esophagitis. Study showed significant healing of oesophagitis in group A after 4 weeks than group B (14%) (P<0.05) but there is no superiority of IR-OMEP over DR-OMEP in relieving symptoms of GERD.Faridpur Med. Coll. J. Jul 2016;11(2): 67-73

scholarly journals Relationship between Long Duration Use of Hormonal Contraceptive and Serum Lipid Profiles among the Women of Dhaka City

2019 ◽  
Vol 6 (1) ◽  
pp. 10-13
Author(s):  
Kashefa Khatun ◽  
Shamsun Nahar ◽  
Abida Sultana ◽  
Shahnur Chisty ◽  
Asma Rumanaz Shahid ◽  
...  
Keyword(s):  
Oral Contraceptive ◽  
Total Cholesterol ◽  
Serum Lipid ◽  
Lipid Profiles ◽  
Hormonal Contraceptives ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Long Duration ◽  
Group A ◽  
Group B

Background: Long duration use of hormonal contraceptives can cause different metabolic effects. Objective: The purpose for the present study was to see the relationship between long duration of use of hormonal contraceptives and serum lipid profiles. Methodology: This cross-sectional study was carried out in the Department of Obstetrics & Gynaecology in collaboration with the Biochemistry Department at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2004 to December 2005 for eighteen (18) months. Women of reproductive age group who had given the history of taking low-dose oral contraceptive pills (OCP) containing 30 meg ethinyloestradiol (EE) plus 150 meg levonorgestrel (LNG) were included as study population. The women were divided into group A which was consisted of women who were using OCP for up to 5 years and group B who were using OCP for more than 5 years. Blood was collected from each woman in fasting state and serum was sent for estimation of serum lipids profiles like serum triglycerides, total cholesterol, LDL and HDL. Result: The women in group A was consisted of 20 women and the rest 20 women were in group B. Comparison of mean age between control and case groups showed no significant difference (31.75±4.85 vs 30.43±5.44 years). In women using OCP ≤5 years and >5 years, the mean (±SD) cholesterol levels were 252.50±48.86 and 239.55±48.73 mg/dl (p>0.10), triglyceride levels were 204.30±48.10 and 191.45±67.89 mg/dL (p>0.10), HDL levels were 42.82±8.96 and 43.00±6.46 (p>0.10) and LDL levels were 168.83±50.82 and 158.26±50.32 (p>0.10) respectively. Conclusion: The level of total cholesterol and triglycerides are not significantly varied with long duration (more than 5 years) of oral contraceptive pills use. Journal of Current and Advance Medical Research 2019;6(1):10-13

scholarly journals Tamoxifen for treatment of abnormal uterine bleeding in etonorgstrel implant users: a randomized clinical trial

2019 ◽  
Vol 8 (11) ◽  
pp. 4462
Author(s):  
Ahmed N. Fetih ◽  
Ahmed M. Abbas ◽  
Fatma A. Kamel ◽  
Ihab H. El Nashar
Keyword(s):  
Oral Contraceptive ◽  
Treatment Time ◽  
Abnormal Uterine Bleeding ◽  
Once Daily ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Tamoxifen Group ◽  
Group A ◽  
The Mean ◽  
Group B

Background: The current study aims to compare the use of tamoxifen and oral contraceptive pills in women using implanon and complain with irregular uterine bleeding.Methods: Women attended family planning clinic using implanon presented by bleeding were invited to participate in the study. They were randomized into two groups: Group A: 100 women received Tamoxifen 10 mg twice daily for 10 days taken at the onset of an episode of bleeding or spotting episode. Group B: 100 women received Combined oral contraceptive pills (microcept) once daily for 21 days take at the onset of an episode of bleeding or spotting episode.Results: No difference regarding the baseline criteria of both groups. No difference between both groups regarding the duration of irregular bleeding in the implanon users (p=0.090). Additionally, the number of bleeding days and spotting in the last month was similar in both groups (p=0.554). The percentage of women who stopped bleeding during the period of treatment is 84% in the tamoxifen group and 92% in the COCs group, but the COCs needs longer treatment time, where the mean of days required to stop bleeding is 5.03±1.8 days in the tamoxifen group and 6.5±2.5 in the COCs group. Headache and nausea were the most prominent adverse effects found in the COCs group (p=0.000).Conclusions: Oral administration of tamoxifen 10 mg twice daily for 10 days is effective on stopping bleeding attacks in implanon users.

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