Continuous subcutaneous hydrocortisone infusion in Addison's disease.
OBJECTIVE
The conventional replacement therapy in Addison's disease (AD) does not restore the normal diurnal cortisol rhythm. We explored the feasibility and safety of continuous s.c. hydrocortisone infusion (CSHI) as a novel mode of glucocorticoid replacement therapy.


METHODS
Seven patients with AD were treated with CSHI in an open-labelled clinical study for up to three months. Adequacy of glucocorticoid replacement was assessed by 24 h blood and saliva sampling in one patient and by salivary cortisol day curves in six outpatients. Subjective health status was monitored by the Short Form-36 questionnaire.


RESULTS
CSHI re-established the circadian variation and normal levels of cortisol in the patients, with minor day-to-day variation. Most of the patients could reduce their glucocorticoid dose considerably without adverse reactions. The treatment was well tolerated and positively evaluated by the patients.


CONCLUSIONS
CSHI is technically feasible and safe in patients with AD. A daily dose of approximately 10 mg/m(2) body surface area/day restores the circadian variation and normal levels of salivary cortisol in most patients, which is close to the estimated daily requirement. We hypothesise that selected patients will benefit from restoration of the circadian cortisol rhythm.
Løvås
Kristian
K
Division of Endocrinology, Institute of Medicine, University of Bergen, Norway. kristian.lovas@med.uib.no
Husebye
Eystein S
ES
D000224:Addison Disease / Q000188:drug therapy*; D000279:Administration, Cutaneous; D000328:Adult; D002940:Circadian Rhythm / Q000187:drug effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000032:analysis; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry / Q000187:drug effects
D006854:Hydrocortisone