Improvement of treatment of primary adrenal insufficiency by administration of cortisone acetate in three daily doses.
In the present study, we compared the effects of 3 daily administrations of cortisone acetate vs a classical regimen with 2 daily administrations, in patients with primary adrenal insufficiency (PAI). We enrolled 34 patients with PAI treated with 2 daily doses of cortisone acetate (2/3 of the total daily dose early in the morning, 1/3 in the afternoon) who were subdivided into two groups: group A (no. = 18; 4 males, 14 females; age: median 55 yr, range 24-88) continued with the standard 2 daily administrations, group B (no. = 16; 8 males, 8 females; age: median 44 yr, range 27-70) switched to 3 daily administrations (3/6 of the daily dose early in the morning, 2/6 after lunch, 1/6 after dinner), but without any change of the total daily dose. After 6 months of therapy, basal and 90-min post-cortisone acetate ACTH levels in group B (219 pg/ml, range 19.9-1197, and 84 pg/ml, range 14.4-480, respectively) were significantly lower than those observed at the beginning of the study (482 pg/ml, range 58-1900 and 215 pg/ml, range 52-1832, respectively; p = 0.001 and p = 0.027, respectively). No statistically significant differences were observed in group A. Similarly, 24-h urinary cortisol (UFC) excretion increased significantly after 6 months of a 3-dose therapy in group B (from 74.6 microg/24 h, range 24-148, to 98.8 microg/24 h, range 48-214; p = 0.006), but not in group A (p = ns). Moreover, UFC excretion after 6 months of a 3-dose therapy was significantly higher than after 6 months of a 2-dose therapy (98.8 microg/24 h, range 48-214 vs 49.8 microg/24 h, range 11-183, p = 0.032). No significant variations of basal and 90-min post-cortisone levels of cortisol were observed in either group. Our study demonstrates that the subdivision of the total daily dose of cortisone acetate in 3 administrations increases total UFC excretion and reduces plasma ACTH levels, thus improving the substitutive therapy.
Department of Internal Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences, University of Perugia, Perugia, Italy. laureti@dimisem.med.unipg.it
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D000309:Adrenal Insufficiency / Q000188:drug therapy*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003348:Cortisone / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric
D000324:Adrenocorticotropic Hormone; D003348:Cortisone; D006854:Hydrocortisone