Empiric Determination of the Daily Glucocorticoid Replacement Dose in Adrenal Insufficiency
Open Access
- 28 September 2020
- journal article
- research article
- Published by The Endocrine Society in Journal of the Endocrine Society
- Vol. 4 (11), bvaa145
- https://doi.org/10.1210/jendso/bvaa145
Abstract
Background For the treatment of adrenal insufficiency (AI) in adults, the Endocrine Society’s recommended daily glucocorticoid replacement dose (DGRD) is 15 to 25 mg hydrocortisone (HC), which is approximately 1.7 times the reported mean daily cortisol production rate. Prolonged glucocorticoid overtreatment causes multiple morbidities. Hypothesis We tested the hypotheses that the DGRD, empirically determined by individual patient titration, is lower than that of the Endocrine Society guidelines and tolerated without evidence of glucocorticoid under-replacement. Methods We empirically determined the DGRD in 25 otherwise healthy adults with AI by titrating the DGRD to the lowest dose tolerated as judged by body mass index, blood pressure, serum sodium concentration and AI symptoms. Patients received either HC or prednisone (PRED). The HC equivalent of PRED was assumed to be 4:1. Results The mean empirically determined DGRD, expressed as HC equivalent, was significantly less than the midpoint of the Endocrine Society’s recommended DGRD (7.6 ± 3.5 mg/m2 vs 11.8 mg/m2; P < 0.001). The DGRD in the adrenalectomy group was not significantly different than the DGRD of those with other AI causes (7.9 ± 4.0 mg/m2 vs 7.3 ± 3.1 mg/m2; P = ns), demonstrating that the empirically determined DGRD was not biased by residual cortisol secretion. There was no evidence of glucocorticoid under-replacement as determined by measured biometrics and AI symptoms. Conclusions We conclude that an empirically determined DGRD is significantly lower than that of the Endocrine Society guidelines and tolerated without evidence of glucocorticoid under-replacement.This publication has 30 references indexed in Scilit:
- Adrenal CrisisThe New England Journal of Medicine, 2019
- Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice GuidelineJournal of Clinical Endocrinology & Metabolism, 2016
- Increased death risk and altered cancer incidence pattern in patients with isolated or combined autoimmune primary adrenocortical insufficiencyClinical Endocrinology, 2008
- Premature Mortality in Patients with Addison’s Disease: A Population-Based StudyJournal of Clinical Endocrinology & Metabolism, 2006
- The Impact of Glucocorticoid Replacement Regimens on Metabolic Outcome and Comorbidity in Hypopituitary PatientsJournal of Clinical Endocrinology & Metabolism, 2006
- Association of 24-Hour Cortisol Production Rates, Cortisol-Binding Globulin, and Plasma-Free Cortisol Levels with Body Composition, Leptin Levels, and Aging in Adult Men and WomenJournal of Clinical Endocrinology & Metabolism, 2004
- Corticosteroid Supplementation for Adrenal InsufficiencyJAMA, 2002
- Bioavailability of oral hydrocortisone in patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiencyJournal of Endocrinology, 2001
- Adrenal InsufficiencyThe New England Journal of Medicine, 1996
- Effect of Glucocorticoid Replacement Therapy on Bone Mineral Density in Patients with Addison DiseaseAnnals of Internal Medicine, 1994