title: Subcutaneous hydrocortisone administration for emergency use in adrenal insufficiency.
abstract: OBJECTIVE
  Evaluation of the pharmacokinetics and safety of s.c. hydrocortisone injection for use in adrenal emergency.
  
  
  METHODS
  Single-center, open-label, sequence-randomized, crossover study in a tertiary care center.
  
  
  METHODS
  Twelve patients with chronic Addison's disease. Comparison of hydrocortisone pharmacokinetics after s.c. and i.m. injection (100 mg) and after s.c. administration of sodium chloride (0.9%) respectively at three different visits.
  
  
  METHODS
  maximum serum cortisol (Cmax), time to Cmax (tmax), and time to serum cortisol >36 μg/dl (tserum cortisol >36 μg/dl) after s.c. administration compared with i.m. administration, safety, and patient preference.
  
  
  RESULTS
  Serum cortisol increased rapidly and substantially after both i.m. and s.c. injections (Cmax: 110±29 vs 97±28 μg/dl, P=0.27, tmax: 66±51 vs 91±34 min, P=0.17, and tserum cortisol >36 μg/dl: 11±5 vs 22±11 min, P=0.004 respectively). Both i.m. and s.c. injections were well tolerated. Eleven (91.7%) patients preferred s.c. injection, whereas one patient did not have any preference.
  
  
  CONCLUSIONS
  S.c. administration of 100 mg hydrocortisone shows excellent pharmacokinetics for emergency use with only a short delay in cortisol increase compared with i.m. injection. It has a good safety profile and is preferred by patients over i.m. injection.
authors.affiliation: Endocrinology and Diabetes Unit, Department of Medicine I, University Hospital Wuerzburg, Oberdürrbacher Strasse 6, D-97080 Wuerzburg, Germany. hahner_s@medizin.uni-wuerzburg.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hahner
authors.forename: Stephanie
authors.initials: S
authors.lastname: Burger-Stritt
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
mesh_terms: D000224:Addison Disease / Q000097:blood* / Q000188:drug therapy* / Q000378:metabolism; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D019540:Area Under Curve; D016009:Chi-Square Distribution; D018592:Cross-Over Studies; D005260:Female; D006207:Half-Life; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics*; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D008297:Male; D057240:Patient Preference; D055815:Young Adult
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone