Switching From Immediate-Release to Fractionated Dual-Release Hydrocortisone May Improve Metabolic Control and QoL in Selected Primary Adrenal Insufficiency Patients
ObjectiveThe use of once-daily dual-release HC (DR-HC) in primary adrenal insufficiency (PAI) is often associated with benefits in metabolic parameters when compared to immediate-release HC (IR-HC). In this study, we evaluated the effects on clinical, biochemical and metabolic parameters of switchin...
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doaj-74aa2a36a93142d88b7265d2c90f48282021-02-01T13:59:37ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922021-02-011110.3389/fendo.2020.610904610904Switching From Immediate-Release to Fractionated Dual-Release Hydrocortisone May Improve Metabolic Control and QoL in Selected Primary Adrenal Insufficiency PatientsFrancesca Delle Cese0Andrea Corsello1Marco Cintoni2Pietro Locantore3Alfredo Pontecorvi4Salvatore Maria Corsello5Rosa Maria Paragliola6Endocrinology, Università Cattolica del Sacro Cuore-Fondazione Policlinico “Gemelli” IRCCS, Rome, ItalyEndocrinology, Università Cattolica del Sacro Cuore-Fondazione Policlinico “Gemelli” IRCCS, Rome, ItalyScuola di Specializzazione in Scienza dell’Alimentazione, Università di Roma Tor Vergata, Rome, ItalyEndocrinology, Università Cattolica del Sacro Cuore-Fondazione Policlinico “Gemelli” IRCCS, Rome, ItalyEndocrinology, Università Cattolica del Sacro Cuore-Fondazione Policlinico “Gemelli” IRCCS, Rome, ItalyEndocrinology, Università Cattolica del Sacro Cuore-Fondazione Policlinico “Gemelli” IRCCS, Rome, ItalyEndocrinology, Università Cattolica del Sacro Cuore-Fondazione Policlinico “Gemelli” IRCCS, Rome, ItalyObjectiveThe use of once-daily dual-release HC (DR-HC) in primary adrenal insufficiency (PAI) is often associated with benefits in metabolic parameters when compared to immediate-release HC (IR-HC). In this study, we evaluated the effects on clinical, biochemical and metabolic parameters of switching from IR-HC to lower-dose DR-HC given both in once and fractionated daily doses.MethodsTwenty autoimmune-PAI subjects were included. Patients on 30 mg/day divided in three doses IR-HC regimen (group A) were switched to DR-HC 25 mg/day given in two daily doses (20 mg in the morning and 5 mg at 2.00 p.m.); patients on 25 mg/day divided in two doses IR-HC regimen (group B) were switched to DR-HC 20 mg once daily. Biochemical and metabolic parameters, BMI and quality of life (QoL) were evaluated at the baseline and six months after the switch.ResultsOur small non-randomized study with short follow up showed significant benefits in both group A and group B without any apparent side-effects. After the switch to DR-HC, a significant decrease in adrenocorticotropic hormone (ACTH), HbA1c, total cholesterol, triglycerides, LDL, cholesterol, BMI as well as a significant improvement in QoL, were observed in both groups. At 6 months, ACTH levels were lower in group A while HbA1C and total cholesterol were lower in group B.ConclusionThe DR-HC is a valid and effective therapeutic strategy to improve the metabolic control and the QoL in PAI. The reduction of ACTH levels with DR-HC regimens reflects a better biochemical control of PAI, obtained by using a lower dose and more physiological HC formulation. Both once-daily and fractionated daily doses of DR-HC showed advantages compared with IR-HC formulation.https://www.frontiersin.org/articles/10.3389/fendo.2020.610904/fullprimary adrenal insufficiencyimmediate-release hydrocortisonemodified-release hydrocortisonedual-release hydrocortisoneadrenocorticotropic hormone |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Francesca Delle Cese Andrea Corsello Marco Cintoni Pietro Locantore Alfredo Pontecorvi Salvatore Maria Corsello Rosa Maria Paragliola |
spellingShingle |
Francesca Delle Cese Andrea Corsello Marco Cintoni Pietro Locantore Alfredo Pontecorvi Salvatore Maria Corsello Rosa Maria Paragliola Switching From Immediate-Release to Fractionated Dual-Release Hydrocortisone May Improve Metabolic Control and QoL in Selected Primary Adrenal Insufficiency Patients Frontiers in Endocrinology primary adrenal insufficiency immediate-release hydrocortisone modified-release hydrocortisone dual-release hydrocortisone adrenocorticotropic hormone |
author_facet |
Francesca Delle Cese Andrea Corsello Marco Cintoni Pietro Locantore Alfredo Pontecorvi Salvatore Maria Corsello Rosa Maria Paragliola |
author_sort |
Francesca Delle Cese |
title |
Switching From Immediate-Release to Fractionated Dual-Release Hydrocortisone May Improve Metabolic Control and QoL in Selected Primary Adrenal Insufficiency Patients |
title_short |
Switching From Immediate-Release to Fractionated Dual-Release Hydrocortisone May Improve Metabolic Control and QoL in Selected Primary Adrenal Insufficiency Patients |
title_full |
Switching From Immediate-Release to Fractionated Dual-Release Hydrocortisone May Improve Metabolic Control and QoL in Selected Primary Adrenal Insufficiency Patients |
title_fullStr |
Switching From Immediate-Release to Fractionated Dual-Release Hydrocortisone May Improve Metabolic Control and QoL in Selected Primary Adrenal Insufficiency Patients |
title_full_unstemmed |
Switching From Immediate-Release to Fractionated Dual-Release Hydrocortisone May Improve Metabolic Control and QoL in Selected Primary Adrenal Insufficiency Patients |
title_sort |
switching from immediate-release to fractionated dual-release hydrocortisone may improve metabolic control and qol in selected primary adrenal insufficiency patients |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Endocrinology |
issn |
1664-2392 |
publishDate |
2021-02-01 |
description |
ObjectiveThe use of once-daily dual-release HC (DR-HC) in primary adrenal insufficiency (PAI) is often associated with benefits in metabolic parameters when compared to immediate-release HC (IR-HC). In this study, we evaluated the effects on clinical, biochemical and metabolic parameters of switching from IR-HC to lower-dose DR-HC given both in once and fractionated daily doses.MethodsTwenty autoimmune-PAI subjects were included. Patients on 30 mg/day divided in three doses IR-HC regimen (group A) were switched to DR-HC 25 mg/day given in two daily doses (20 mg in the morning and 5 mg at 2.00 p.m.); patients on 25 mg/day divided in two doses IR-HC regimen (group B) were switched to DR-HC 20 mg once daily. Biochemical and metabolic parameters, BMI and quality of life (QoL) were evaluated at the baseline and six months after the switch.ResultsOur small non-randomized study with short follow up showed significant benefits in both group A and group B without any apparent side-effects. After the switch to DR-HC, a significant decrease in adrenocorticotropic hormone (ACTH), HbA1c, total cholesterol, triglycerides, LDL, cholesterol, BMI as well as a significant improvement in QoL, were observed in both groups. At 6 months, ACTH levels were lower in group A while HbA1C and total cholesterol were lower in group B.ConclusionThe DR-HC is a valid and effective therapeutic strategy to improve the metabolic control and the QoL in PAI. The reduction of ACTH levels with DR-HC regimens reflects a better biochemical control of PAI, obtained by using a lower dose and more physiological HC formulation. Both once-daily and fractionated daily doses of DR-HC showed advantages compared with IR-HC formulation. |
topic |
primary adrenal insufficiency immediate-release hydrocortisone modified-release hydrocortisone dual-release hydrocortisone adrenocorticotropic hormone |
url |
https://www.frontiersin.org/articles/10.3389/fendo.2020.610904/full |
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