Prevention of Adrenal Crisis: Cortisol Responses to Major Stress Compared to Stress Dose Hydrocortisone Delivery
| Autor: | Donna M. O'Neil, Wiebke Arlt, John A.H. Wass, Christopher J Mowatt, Joanne L. Fallowfield, Janet M. Lord, John Komninos, Angela E Taylor, Dimitra Vassiliadi, Irina Bancos, Alessandro Prete, Radu Mihai, Violet Fazal-Sanderson, Sibylle Kohler, Djillali Annane, Brian G. Keevil, David J. Smith, Mark A. Foster, Niki Karavitaki |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Hydrocortisone Endocrinology Diabetes and Metabolism Clinical Biochemistry Administration Oral 030204 cardiovascular system & hematology Biochemistry Mass Spectrometry Primary Adrenal Insufficiency surgery stress 0302 clinical medicine Endocrinology Bolus (medicine) Infusions Intravenous Aged 80 and over Clinical Research Article Adrenal crisis Middle Aged Treatment Outcome Female medicine.symptom AcademicSubjects/MED00250 Glucocorticoid medicine.drug Adult medicine.medical_specialty Adolescent 030209 endocrinology & metabolism cortisol Drug Administration Schedule Sepsis Young Adult 03 medical and health sciences Stress Physiological Internal medicine medicine Adrenal insufficiency Humans Glucocorticoids Aged business.industry Biochemistry (medical) medicine.disease Cortisone Cross-Sectional Studies business Stress Psychological Adrenal Insufficiency |
| Zdroj: | The Journal of Clinical Endocrinology and Metabolism |
| ISSN: | 1945-7197 0021-972X |
| Popis: | Context Patients with adrenal insufficiency require increased hydrocortisone cover during major stress to avoid a life-threatening adrenal crisis. However, current treatment recommendations are not evidence-based. Objective To identify the most appropriate mode of hydrocortisone delivery in patients with adrenal insufficiency who are exposed to major stress. Design and Participants Cross-sectional study: 122 unstressed healthy subjects and 288 subjects exposed to different stressors (major trauma [N = 83], sepsis [N = 100], and combat stress [N = 105]). Longitudinal study: 22 patients with preserved adrenal function undergoing elective surgery. Pharmacokinetic study: 10 patients with primary adrenal insufficiency undergoing administration of 200 mg hydrocortisone over 24 hours in 4 different delivery modes (continuous intravenous infusion; 6-hourly oral, intramuscular or intravenous bolus administration). Main Outcome Measure We measured total serum cortisol and cortisone, free serum cortisol, and urinary glucocorticoid metabolite excretion by mass spectrometry. Linear pharmacokinetic modeling was used to determine the most appropriate mode and dose of hydrocortisone administration in patients with adrenal insufficiency exposed to major stress. Results Serum cortisol was increased in all stress conditions, with the highest values observed in surgery and sepsis. Continuous intravenous hydrocortisone was the only administration mode persistently achieving median cortisol concentrations in the range observed during major stress. Linear pharmacokinetic modeling identified continuous intravenous infusion of 200 mg hydrocortisone over 24 hours, preceded by an initial bolus of 50–100 mg hydrocortisone, as best suited for maintaining cortisol concentrations in the required range. Conclusions Continuous intravenous hydrocortisone infusion should be favored over intermittent bolus administration in the prevention and treatment of adrenal crisis during major stress. |
| Databáze: | OpenAIRE |
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