Endocrine Abstracts (2009) 20 P29

Glucocorticoid replacement therapy in adrenocortical insufficiency

Anna Rita Carli, Gemma Frigato, Marta Bondanelli, Maria Chiara Zatelli, Maria Rosaria Ambrosio & Ettore de gli Uberti


Section of Endocrinology, Department of Biomedical Sciences and Advanced Therapy, University of Ferrara, Ferrara, Italy.


The effectiveness of glucocorticoid replacement therapy is based on clinical criteria, since objectives parameters are not standardized. The purpose of our study was to assess the adequacy of replacement therapy with cortisone acetate, trying to identify parameters indicating proper replacement. We studied 22 patients with adrenal insufficiency (7 primary and 15 secondary) treated with cortisone acetate (mean daily dose 36.5+/−2.1 mg at 0800 a.m. and 0300 p.m.), and six control subjects. Serum cortisol was evaluated in all the patients at 0800 at 0200, with drawings every hour, with parallel 24 h urinary free cortisol evaluation. The quality of life was assessed by standard questionnaires SF-36.

The 12 h trend of serum cortisol in patients did not overlap with that of controls. In patients, serum cortisol peak was noted 2 h after the morning dose and 1 h after the afternoon dose, being significantly increased compared with controls. Urinary free cortisol levels were normal in all patients. The quality of life was compromised in patients compared with controls, since greater impairment of physical or psychological well-being was associated with low serum cortisol levels recorded at 2 and 3 p.m., before to the second drug dose. Our data suggest that plasma cortisol evaluation performed 2 h after the morning dose and 1 h after the afternoon dose may be useful to monitor the replacement treatment with cortisone acetate. In particular, the morning peak reflects the physiological peak, while the afternoon peak may provide useful information on a possible under-dosage, suggesting a different schedule of drug administration. In our study, impaired physical or psychological well-being is associated with low serum cortisol levels, suggesting that a three dose administration schedule might be useful to improve the quality of life.

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