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Endocrine Abstracts (2015) 39 OC6.7 | DOI: 10.1530/endoabs.39.OC6.7

BSPED2015 ORAL COMMUNICATIONS Oral Communications 6 (10 abstracts)

Standard and modified release hydrocortisone formulations: cortisol levels and patient preference

J Park 1 , T Henderson 2 , H Leyland 2 , U Das 1 , M Didi 1 , R Ramakrishnan 1 , M Peak 3 & J Blair 1


1Alder Hey Children’s Hospital, Liverpool, UK; 2NIHR Clinical Research Facility, Liverpool, UK; 3Clinical Research Business Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK.


Background: Cortisol profiles during treatment with standard hydrocortisone (StdHC) formulations are unphysiological. Some patients, with low cortisol levels between doses, experience symptomatic hypocortisolaemia and may benefit from modified release hydrocortisone (MRHC). Plenadren is a MRHC licensed for once daily dosing in adults.

We offered Plenadren to patients with symptomatic hypocortisolaemia, documented to occur at times of low cortisol levels, and persisting despite manipulations in size and frequency of StdHC doses.

Aims and objectives: To describe: i) peak cortisol and time to cortisol <100 nmol/l after a dose of StdHC and Plenadren and ii) patient preference for StdHC and Plenadren.

Methods: Plenadren doses were calculated from total daily dose (TDD) of StdHC, rounded up to nearest 5 mg: 2/3 on waking, 1/3 at 1530–1630 h. Plasma cortisol was measured 2-h during StdHC treatment, and the following day after the morning dose of Plenadren. Plenadren doses were adjusted and treatment continued for 3 months when patients were offered continuing treatment with Plenadren or StdHC.

Results: Since 2012, eight patients (5M) age 11 years (8.8–13.3) with Addison’s disease (n=3), pituitary irradiation/surgery (n=2), adrenal suppression (n=2), and pituitary compression (n=1), receiving StdHC 12.6 mg/m2 per day (10.5–17.8), have been treated.

Following StdHC 6.1 mg/m2 (3.3–7.1) and Plenadren 10 mg/m2 (8.3–16.7), peak cortisol was 360.7 nmol/l (154–654) and 346 nmol/l (150–466) (P=0.82), and plasma cortisol <100 nmol/l at 4 h: n=7 and n=1, 6 h: n=7 and n=4, and 8 h: N/A, n=7 respectively.

Plenadren was given twice (n=4) or three times daily (n=4). After 3 months, six patients reported fewer headaches, improved energy, and school attendance. Two patients complained of nausea and resorted to StdHC.

Conclusions: In this small, highly selected cohort, two to three daily doses of Plenadren were required to maintain cortisol >100 nmol/l. Self-reported measures suggest some benefit from MRHC. Rigorous clinical trials are required to examine the place of MRHC in paediatric practice.

Volume 39

43rd Meeting of the British Society for Paediatric Endocrinology and Diabetes

British Society for Paediatric Endocrinology and Diabetes 

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