Cortisol replacement therapy for adults

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Ross Corresponding author. Traditionally hydrocortisone has been the first choice for replacement therapy in patients with adrenal insufficiency. Paediatricians have used body surface area adjusted dosing and adult physicians have tended to use fixed doses twice or thrice daily.

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Searchable abstracts of presentations at key conferences in endocrinology. Conventional hydrocortisone dosing does not mimic the normal cortisol circadian rhythm making treatment optimisation difficult in patients with adrenal insufficiency. We described the first use of a continuous variable subcutaneous hydrocortisone infusion CSHI via an insulin pump to replace cortisol in a patient with congenital adrenal hyperplasia CAH to mimic the normal plasma cortisol circadian rhythm.

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Addisons disease is a rare endocrine, or hormonal disorder that affects about 1 inpeople. It occurs in all age groups and afflicts men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and non-exposed parts of the body.

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The adrenal gland is divided into the adrenal medulla, which produces catecholamines such as epinephrine and norepinephrine, and the adrenal cortex, which produces cortical steroids such as cortisol, aldosterone, and androgens, all of which are needed to maintain homeostasis in the body. The adrenal cortex is further subdivided into 3 regions: the zona glomerulosa, which is responsible for producing mineralocorticoids eg, aldosterone ; the zona fasciculata, which secretes glucocorticoids eg, cortisol ; and the zona reticularis, which releases androgens eg, testosterone. The levels of these cortical steroids are regulated through the hypothalamuspituitary-adrenal HPA axis Figure. In response to inadequate levels of cortical steroids in the body, the hypothalamus will secrete corticotropin-releasing hormone CRHwhich exerts a positive feedback on the anterior pituitary gland to release adrenocorticotropic hormone ACTH.

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By intravenous injection, or by intravenous infusion. Initially by intravenous injection, or by intravenous infusion. By mouth using immediate-release medicines.

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Congenital adrenal hyperplasia is an inherited condition caused by mutations in genes that code for enzymes involved in making steroid hormones in the adrenal glands. Congenital adrenal hyperplasia results from mutations in the gene that codes for one of several enzymes responsible for making steroid hormones in the adrenal glands. The most common enzyme to be affected is hydroxylase, which is a key regulator in the synthesis of the stress hormone cortisol.

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Patients with adrenal insufficiency AI require additional glucocorticoid doses during surgery or medical illness, but there is no universally accepted regimen for glucocorticoid supplementation therapy. The high doses and long duration of glucocorticoid coverage that have traditionally been used do not reflect the hypothalamic—pituitary—adrenal response to surgical stress and medical illness in normal people. While the optimal dose and duration of supplementation therapy have not been established, our recommendations are based on extrapolation from what constitutes a normal cortisol response to stress, on expert opinion derived from the medical literature, and on clinical experience.

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Better timing for cortisol replacement therapies, to more closely replicate the secretion patterns of people with normal levels of the hormone, has shown a significant improvement in patients' cognitive function. The findings are potentially important and underline the case for novel therapeutic approaches, as patients on cortisol replacement therapy often have side effects that make it difficult for them to lead normal lives. Cortisol is a key hormone that is critical for the maintenance of life.

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Cortisol has one of the most distinct and fascinating circadian rhythms in human physiology. This is regulated by the central clock located in the suprachiasmatic nucleus of the hypothalamus. It has been suggested that cortisol acts as a secondary messenger between central and peripheral clocks, hence its importance in the synchronization of body circadian rhythms.

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Adrenal insufficiency, primarily presenting as an adrenal crisis, is a life-threatening emergency and requires prompt therapeutic management including fluid resuscitation and stress dose hydrocortisone administration. Primary adrenal insufficiency is most frequently caused by autoimmune adrenalitis, and hypothalamic-pituitary tumors represent the most frequent cause of secondary adrenal insufficiency. However, the exact underlying diagnosis needs to be confirmed by a stepwise diagnostic approach, with an open eye for other differential diagnostic possibilities. Chronic replacement therapy with glucocorticoids and, in primary adrenal insufficiency, mineralocorticoids requires careful monitoring.


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