Endocrine Abstracts

The current conventional glucocorticoid (GC) replacement therapy in primary adrenal insufficiency (Addison’s disease) and congenital adrenal hyperplasia (CAH) renders the cortisol levels unphysiological, resulting in very high levels alternating with almost undetectable levels of cortisol over the day. This reduces not merely the patient’s quality of life but increases the patient’s morbidity and mortality. The HPA axis is characterised by a dynamic circadian variation of cortisol with highest circulating levels in the early morning and a nadir late in the evening. The current therapeutical approach does not restore the circadian rhythm of cortisol. Recently replacement by continuous subcutaneous hydrocortisone infusion (CSHI) has been shown to mimic the circadian cortisol rhythm (Oksnes et al. 2014). CSHI treatment requires proper patient education and close monitoring during the first week of treatment until the correct dosage of hydrocortisone is defined. The starting dose is calculated according to body surface area and divided into four dosing intervals per day, corresponding with the circadian rhythm of cortisol. During the first day, the patient may report clinical signs of under-treatment; thus it is essential that the patient is thoroughly informed, and has the possibility to contact the physician directly if needed. The cortisol dosage should be double-checked in one week with serum cortisol, ACTH, cortisol saliva profile, and (possibly) 24 h urine collection, allowing for dose adjustment. In case of any illness the patient has to switch to the conventional tablet treatment and increase the dose of hydrocortisone according to the recommendation.

Disclosure: The work was supported by grant of Helse-Bergen Norway.