title: Is physiological glucocorticoid replacement important in children?
abstract: Cortisol has a distinct circadian rhythm with low concentrations at night, rising in the early hours of the morning, peaking on waking and declining over the day to low concentrations in the evening. Loss of this circadian rhythm, as seen in jetlag and shift work, is associated with fatigue in the short term and diabetes and obesity in the medium to long term. Patients with adrenal insufficiency on current glucocorticoid replacement with hydrocortisone have unphysiological cortisol concentrations being low on waking and high after each dose of hydrocortisone. Patients with adrenal insufficiency complain of fatigue, a poor quality of life and there is evidence of poor health outcomes including obesity potentially related to glucocorticoid replacement. New technologies are being developed that deliver more physiological glucocorticoid replacement including hydrocortisone by subcutaneous pump, Plenadren, a once-daily modified-release hydrocortisone and Chronocort, a delayed and sustained absorption hydrocortisone formulation that replicates the overnight profile of cortisol. In this review, we summarise the evidence regarding physiological glucocorticoid replacement with a focus on relevance to paediatrics.
authors: Diurnal Ltd, Cardiff, UK.
authors: John
authors: J
authors: Porter
authors: Department of Endocrinology, Alder Hey Children's Hospital, Liverpool, UK.
authors: Joanne
authors: J
authors: Blair
authors: Diurnal Ltd, Cardiff, UK.|Department of Endocrinology, The University of Sheffield, Sheffield, UK.
authors: Richard J
authors: RJ
authors: Ross
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital; D000309:Adrenal Insufficiency / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm / Q000502:physiology*; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism* / Q000627:therapeutic use; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010913:Pituitary-Adrenal System / Q000502:physiology; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D006854:Hydrocortisone
keywords: Adrenal Insufficiency; Circadian rhythms; Congenital Adrenal Hyperplasia; Cortisol; Glucocorticoid