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What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study
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...
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| Published in: | Journal of endocrinological investigation 2021-04, Vol.44 (4), p.865-872 |
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| creator | Puglisi, S. Rossini, A. Tabaro, I. Cannavò, S. Ferrau’, F. Ragonese, M. Borretta, G. Pellegrino, M. Dughera, F. Parisi, A. Latina, A. Pia, A. Terzolo, M. Reimondo, G. |
| description | 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. |
| doi_str_mv | 10.1007/s40618-020-01386-3 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7946659</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2432857042</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-ff782987e7a8a9283e5711de166abae939ba55c7730d3f3d784628b7bc0b943e3</originalsourceid><addsrcrecordid>eNp9kUtv1TAQhS1ERUvhD7BAltiwCfUjiW0WSFXFS6rEBsTSmjjje1058cVOKt1_j8stpXTRledovjke-xDyirN3nDF1VlrWc90wwRrGpe4b-YSccFWlrurpvfqYPC_lijGppFbPyLEUShnO-hMy_NzCQj24JeVCt3CNNEy7Kmma6SauLrmUl-BSGGnGXQSHE84LDTOFMeMMsZZl9T64gLPbv6dQOYhNDB5pWdZx_4IceYgFX96ep-THp4_fL740l98-f704v2xcq9ql8V5pYbRCBRqM0BI7xfmIvO9hADTSDNB1TinJRunlqHTbCz2owbHBtBLlKflw8N2tw4Sjq2tmiHaXwwR5bxME-39nDlu7SddWmbbvO1MN3t4a5PRrxbLYKRSHMcKMaS1WtFLoTrFWVPTNA_Qqrbn-xg1ljNF9dayUOFAup1Iy-rtlOLM3EdpDhLZGaP9EaGUden3_GXcjfzOrgDwApbbmDeZ_dz9i-xtZhqh-</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2499986665</pqid></control><display><type>article</type><title>What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study</title><source>Springer Link</source><creator>Puglisi, S. ; Rossini, A. ; Tabaro, I. ; Cannavò, S. ; Ferrau’, F. ; Ragonese, M. ; Borretta, G. ; Pellegrino, M. ; Dughera, F. ; Parisi, A. ; Latina, A. ; Pia, A. ; Terzolo, M. ; Reimondo, G.</creator><creatorcontrib>Puglisi, S. ; Rossini, A. ; Tabaro, I. ; Cannavò, S. ; Ferrau’, F. ; Ragonese, M. ; Borretta, G. ; Pellegrino, M. ; Dughera, F. ; Parisi, A. ; Latina, A. ; Pia, A. ; Terzolo, M. ; Reimondo, G.</creatorcontrib><description>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.</description><identifier>ISSN: 1720-8386</identifier><identifier>ISSN: 0391-4097</identifier><identifier>EISSN: 1720-8386</identifier><identifier>DOI: 10.1007/s40618-020-01386-3</identifier><identifier>PMID: 32779106</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acetic acid ; Body weight ; Dosage ; Endocrinology ; Etiology ; Glucocorticoids ; Hydrocortisone ; Internal Medicine ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Original ; Original Article ; Patients</subject><ispartof>Journal of endocrinological investigation, 2021-04, Vol.44 (4), p.865-872</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-ff782987e7a8a9283e5711de166abae939ba55c7730d3f3d784628b7bc0b943e3</citedby><cites>FETCH-LOGICAL-c474t-ff782987e7a8a9283e5711de166abae939ba55c7730d3f3d784628b7bc0b943e3</cites><orcidid>0000-0002-2883-6139</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,786,790,891,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32779106$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Puglisi, S.</creatorcontrib><creatorcontrib>Rossini, A.</creatorcontrib><creatorcontrib>Tabaro, I.</creatorcontrib><creatorcontrib>Cannavò, S.</creatorcontrib><creatorcontrib>Ferrau’, F.</creatorcontrib><creatorcontrib>Ragonese, M.</creatorcontrib><creatorcontrib>Borretta, G.</creatorcontrib><creatorcontrib>Pellegrino, M.</creatorcontrib><creatorcontrib>Dughera, F.</creatorcontrib><creatorcontrib>Parisi, A.</creatorcontrib><creatorcontrib>Latina, A.</creatorcontrib><creatorcontrib>Pia, A.</creatorcontrib><creatorcontrib>Terzolo, M.</creatorcontrib><creatorcontrib>Reimondo, G.</creatorcontrib><title>What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study</title><title>Journal of endocrinological investigation</title><addtitle>J Endocrinol Invest</addtitle><addtitle>J Endocrinol Invest</addtitle><description>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.</description><subject>Acetic acid</subject><subject>Body weight</subject><subject>Dosage</subject><subject>Endocrinology</subject><subject>Etiology</subject><subject>Glucocorticoids</subject><subject>Hydrocortisone</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Original</subject><subject>Original Article</subject><subject>Patients</subject><issn>1720-8386</issn><issn>0391-4097</issn><issn>1720-8386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kUtv1TAQhS1ERUvhD7BAltiwCfUjiW0WSFXFS6rEBsTSmjjje1058cVOKt1_j8stpXTRledovjke-xDyirN3nDF1VlrWc90wwRrGpe4b-YSccFWlrurpvfqYPC_lijGppFbPyLEUShnO-hMy_NzCQj24JeVCt3CNNEy7Kmma6SauLrmUl-BSGGnGXQSHE84LDTOFMeMMsZZl9T64gLPbv6dQOYhNDB5pWdZx_4IceYgFX96ep-THp4_fL740l98-f704v2xcq9ql8V5pYbRCBRqM0BI7xfmIvO9hADTSDNB1TinJRunlqHTbCz2owbHBtBLlKflw8N2tw4Sjq2tmiHaXwwR5bxME-39nDlu7SddWmbbvO1MN3t4a5PRrxbLYKRSHMcKMaS1WtFLoTrFWVPTNA_Qqrbn-xg1ljNF9dayUOFAup1Iy-rtlOLM3EdpDhLZGaP9EaGUden3_GXcjfzOrgDwApbbmDeZ_dz9i-xtZhqh-</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Puglisi, S.</creator><creator>Rossini, A.</creator><creator>Tabaro, I.</creator><creator>Cannavò, S.</creator><creator>Ferrau’, F.</creator><creator>Ragonese, M.</creator><creator>Borretta, G.</creator><creator>Pellegrino, M.</creator><creator>Dughera, F.</creator><creator>Parisi, A.</creator><creator>Latina, A.</creator><creator>Pia, A.</creator><creator>Terzolo, M.</creator><creator>Reimondo, G.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2883-6139</orcidid></search><sort><creationdate>20210401</creationdate><title>What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study</title><author>Puglisi, S. ; Rossini, A. ; Tabaro, I. ; Cannavò, S. ; Ferrau’, F. ; Ragonese, M. ; Borretta, G. ; Pellegrino, M. ; Dughera, F. ; Parisi, A. ; Latina, A. ; Pia, A. ; Terzolo, M. ; Reimondo, G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-ff782987e7a8a9283e5711de166abae939ba55c7730d3f3d784628b7bc0b943e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acetic acid</topic><topic>Body weight</topic><topic>Dosage</topic><topic>Endocrinology</topic><topic>Etiology</topic><topic>Glucocorticoids</topic><topic>Hydrocortisone</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Original</topic><topic>Original Article</topic><topic>Patients</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Puglisi, S.</creatorcontrib><creatorcontrib>Rossini, A.</creatorcontrib><creatorcontrib>Tabaro, I.</creatorcontrib><creatorcontrib>Cannavò, S.</creatorcontrib><creatorcontrib>Ferrau’, F.</creatorcontrib><creatorcontrib>Ragonese, M.</creatorcontrib><creatorcontrib>Borretta, G.</creatorcontrib><creatorcontrib>Pellegrino, M.</creatorcontrib><creatorcontrib>Dughera, F.</creatorcontrib><creatorcontrib>Parisi, A.</creatorcontrib><creatorcontrib>Latina, A.</creatorcontrib><creatorcontrib>Pia, A.</creatorcontrib><creatorcontrib>Terzolo, M.</creatorcontrib><creatorcontrib>Reimondo, G.</creatorcontrib><collection>SpringerOpen</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of endocrinological investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Puglisi, S.</au><au>Rossini, A.</au><au>Tabaro, I.</au><au>Cannavò, S.</au><au>Ferrau’, F.</au><au>Ragonese, M.</au><au>Borretta, G.</au><au>Pellegrino, M.</au><au>Dughera, F.</au><au>Parisi, A.</au><au>Latina, A.</au><au>Pia, A.</au><au>Terzolo, M.</au><au>Reimondo, G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study</atitle><jtitle>Journal of endocrinological investigation</jtitle><stitle>J Endocrinol Invest</stitle><addtitle>J Endocrinol Invest</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>44</volume><issue>4</issue><spage>865</spage><epage>872</epage><pages>865-872</pages><issn>1720-8386</issn><issn>0391-4097</issn><eissn>1720-8386</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32779106</pmid><doi>10.1007/s40618-020-01386-3</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2883-6139</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Springer Link |
| subjects | Acetic acid Body weight Dosage Endocrinology Etiology Glucocorticoids Hydrocortisone Internal Medicine Medicine Medicine & Public Health Metabolic Diseases Original Original Article Patients |
| title | What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study |
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