What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study

Autor: Massimo Terzolo, Giuseppe Reimondo, A. Rossini, Francesco Ferraù, S. Cannavò, Anna Pia, Marta Ragonese, Soraya Puglisi, Giorgio Borretta, A. Latina, A. Parisi, Isabella Tabaro, Micaela Pellegrino, Francesca Dughera
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Hydrocortisone
Hormone Replacement Therapy
Endocrinology
Diabetes and Metabolism
Fludrocortisone
030209 endocrinology & metabolism
Gastroenterology
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Endocrinology
Sex Factors
Internal medicine
Hypoadrenalism
medicine
Adrenal insufficiency
Humans
Drug Dosage Calculations
Dosing
Addison
Management
Glucocorticoids
Retrospective Studies
Dose-Response Relationship
Drug
business.industry
Body Weight
Middle Aged
medicine.disease
Patient Care Management
Cortisone
Addison
Fludrocortisone
Hydrocortisone
Hypoadrenalism
Management
Italy
030220 oncology & carcinogenesis
Etiology
Original Article
Female
Risk Adjustment
business
Life study
Glucocorticoid
medicine.drug
Adrenal Insufficiency
Follow-Up Studies
Zdroj: Journal of Endocrinological Investigation
ISSN: 1720-8386
0391-4097
Popis: Purpose 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. Methods 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. Results 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). Conclusions 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.
Databáze: OpenAIRE
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