Reverse circadian glucocorticoid treatment in prepubertal children with congenital adrenal hyperplasia
| Autor: | Nicole Reisch, Susanne Bechtold Dalla-Pozza, Martin Bidlingmaier, Ilja Dubinski, Heinrich Schmidt |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Evening Endocrinology Diabetes and Metabolism law.invention Endocrinology Randomized controlled trial law medicine Humans Congenital adrenal hyperplasia Child Glucocorticoids Retrospective Studies Hydrocortisone Morning Adrenal Hyperplasia Congenital business.industry 17-alpha-Hydroxyprogesterone Adrenal crisis Prognosis medicine.disease Circadian Rhythm Child Preschool Pediatrics Perinatology and Child Health Female medicine.symptom business Biomarkers Glucocorticoid Steroid hormone metabolism Follow-Up Studies medicine.drug |
| Zdroj: | Journal of Pediatric Endocrinology and Metabolism. 34:1543-1548 |
| ISSN: | 2191-0251 0334-018X |
| DOI: | 10.1515/jpem-2021-0540 |
| Popis: | Objectives Children with salt-wasting congenital adrenal hyperplasia (CAH) have an impaired function of steroid synthesis pathways. They require therapy with glucocorticoid (GC) and mineralocorticoid hormones to avoid salt-wasting crisis and other complications. Most commonly, children receive hydrocortisone thrice daily with the highest dose in the morning, mimicking the regular physiology. However, reverse circadian treatment (RCT) had been suggested previously. In this study, we aimed to determine the efficacy of RCT in prepubertal children with CAH by comparing the salivary 17-hydroxyprogesterone (s17-OHP) levels individually. Methods In this retrospective study, we analyzed the records of children with classical CAH and RCT who were monitored by s17-OHP levels. The study included 23 patients. We identified nine prepubertal children with RCT schemes (three boys and six girls) and compared the s17-OHP levels in the morning, afternoon, and evening. The objective of this study was to demonstrate the non-effectiveness of RCT in terms of lowering the morning s17-OHP concentration. In addition, we compared s17-OHP day profiles in six patients on RCT and non-RCT therapy (intraindividually). Results Eight of nine children with RCT showed higher s17-OHP levels in the morning compared to the evening. In addition, none of the children showed a significant deviation of development. Three children were overweight. No adrenal crisis or pubertal development occurred. Comparison of RCT and non-RCT regimens showed no difference in 17-OHP profiles. Conclusions Our data do not support the use of RCT schemes for GC replacement in children with CAH due to lack of benefits and unknown long-term risks. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|