title: Temporal and individual variations in the dose of glucocorticoid used for the treatment of salt-losing congenital virilizing adrenal hyperplasia due to 21-hydroxylase deficiency.
abstract: The dose of glucocorticoid was evaluated in the treatment of 19 patients with salt-losing congenital adrenal hyperplasia due to complete or nearly complete 21-hydroxylase deficiency. In most cases, follow-up was from infancy to puberty. The dose of steroid was expressed as oral cortisol (mg/m2 body surface area/24 hours); the equivalent doses of the various glucocorticoid preparations was as follows: 100 mg oral cortisol = 120 mg oral cortisone acetate = 25 mg oral prednisone = 50 mg intramuscular cortisol = 60 mg intramuscular cortisone acetate. The dose of glucocorticoid producing good laboratory and clinical control varied significantly with age. The dose fell from 26 mg/m2/24 hours in early infancy to 19 mg/m2/24 hours between 6 and 8 years of age, and then rose to 23-24 mg/m2/hour in adolescence. In addition to these age-related changes, there were large individual variations at each age. Indeed, the values from 4 of the 19 patients were not included in the calculation of the mean because they were more than 3 SD either above or below the mean. For the rest of the patients, the coefficient of variation ranged from 14.5% to 37.2%. It is concluded that glucocorticoid therapy must be adjusted carefully to the age and needs of each patient.
authors.affiliation: Division of Pediatric Endocrinology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: R
authors.initials: R
authors.lastname: Sandrini
authors.forename: N
authors.initials: N
authors.lastname: Jospe
authors.forename: C J
authors.initials: CJ
authors.lastname: Migeon
mesh_terms: D015068:17-Ketosteroids / Q000652:urine; D000284:Administration, Oral; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D000365:Age Determination by Skeleton; D000367:Age Factors; D001827:Body Height / Q000187:drug effects; D001830:Body Surface Area; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000145:classification / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D013810:Therapeutic Equivalency
chemical_list: D015068:17-Ketosteroids; D005938:Glucocorticoids