Corticoid therapy: how?
Corticosteroids are very active medicines. The use of a high dose of glucocorticoids will suppress the pituitary adrenal axis. In the use of the medication a knowledge of the equivalency of the different preparations is necessary (hydrocortisone 1, prednisolone 4, dexamethasone 25). The ultimate dose will be differentiated and adapted to the basal disease. In the cutting down of a long therapy with corticoids (greater than 6 weeks with a dose more than 7.5 mg prednisolone a day or equivalent) a long and careful running down period is necessary. At first, a switch over to a normal substitutive treatment (20 and 10 mg hydrocortisone a day) is necessary. At regular intervals the recovery of the adrenal will be tested. If a sufficient basal level of cortisol is obtained a dynamic exploration using ACTH and insulin will be performed. It is only after a sufficient insulin response that can be concluded to a recovery of the adrenal to stress.
Rubens
R
R
Department of Endocrinology, State University Hospital, Gent, Belgium.
D000324:Adrenocorticotropic Hormone / Q000037:antagonists & inhibitors; D004305:Dose-Response Relationship, Drug; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006207:Half-Life; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D010902:Pituitary Gland / Q000187:drug effects; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy
D005938:Glucocorticoids; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone