PDF herunterladen
Horm Metab Res 2015; 47(09): 637-642
DOI: 10.1055/s-0035-1548869
Kategorie: Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Modern Hydrocortisone Replacement Regimens in Adrenal Insufficiency Patients and the Risk of Adrenal Crisis

R. L. Rushworth
1   School of Medicine, Sydney, The University of Notre Dame, Australia, Darlinghurst, Australia
,
D. J. Torpy
2   Endocrine and Metabolic Unit, Royal Adelaide Hospital and University of Adelaide North Terrace, Adelaide, Australia
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 19. November 2014

accepted 13. März 2015

Publikationsdatum:
07. Mai 2015 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

The aim of this study was to examine the incidence of adrenal crises (AC) and the prescription of short-acting glucocorticoids (GC) in different geographic areas. To do this we conducted a descriptive study of AC hospitalisations and prescriptions for two GCs (hydrocortisone (HC) and cortisone acetate (CA)), and fludrocortisone acetate (FA), in different geographic areas of Australia between 1999/2000 and 2011/2012, using government databases.

There were 2 584 hospital admissions for AC in Australia between 1999/00 and 2011/12 and the corresponding admission rates increased significantly from 7.4 to 11.1/106/year (p<0.001). AC admission rates increased in 5 out of 6 geographic areas. Prescription rates for the combined GCs (HC/CA) increased at an annual rate of between 0.2–2.0% in all areas. All areas had significant (p<0.01) increases in HC prescription rates (4.5% to 13.7% annually) and CA prescription rates decreased in 5 out of the 6 regions (3.5% annual decrease to a 0.5% annual increase). When the geographic areas were combined, there was a significant correlation between the AC admission rates and HC/CA prescription rates (r=0.30, p<0.01). Admissions for AC and GC prescriptions increased significantly in Australia after 1999 and these varied significantly by geographic area. These results suggest that modern recommendations for lower dose, short-acting GC replacement may be of concern and further investigation is warranted.

Key words

adrenal insufficiency - adrenal crisis - glucocorticoid replacement - hydrocortisone - cortisone acetate
 

  • References

  • 1 Hahner S, Loeffler M, Bleicken B, Drechsler C, Milovanovic D, Fassnacht M, Ventz M, Quinkler M, Allolio B. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol 2010; 162: 597-602
    CrossrefPubMedGoogle Scholar
  • 2 Hahner S, Spinnler C, Fassnacht M, Burger-Stritt S, Lang K, Milovanovic D, Beuschlein F, Willenberg HS, Quinkler M, Allolio B. High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency – a prospective study. J Clin Endocrinol Metab 2015; 100: 407-416
    CrossrefPubMedGoogle Scholar
  • 3 Erichsen MM, Løvås K, Fougner KJ, Svartberg J, Hauge ER, Bollerslev J, Berg JP, Mella B, Husebye ES. Normal overall mortality rate in Addison’s disease, but young patients are at risk of premature death. Eur J Endocrinol 2009; 160: 233-237
    CrossrefPubMedGoogle Scholar
  • 4 Burman P, Mattsson AF, Johannsson G, Höybye C, Holmer H, Dahlqvist P, Berinder K, Engström BE, Ekman B, Erfurth EM, Svensson J, Wahlberg J, Karlsson FA. Deaths among adult patients with hypopituitarism: hypocortisolism during acute stress, and de novo malignant brain tumors contribute to an increased mortality. J Clin Endocrinol Metab 2013; 98: 1466-1475
    CrossrefPubMedGoogle Scholar
  • 5 Leelarathna L, Breen L, Powrie JK, Thomas SM, Guzder R, McGowan B, Carroll PV. Co-morbidities management and clinical outcome of auto-immune Addison’s disease. Endocrine 2010; 38: 113-117
    CrossrefPubMedGoogle Scholar
  • 6 Smans LCCJ, Souverein PC, Leufkens HGM, Hoepelman AIM, Zelissen PMJ. Increased use of antimicrobial agents and hospital admission for infections in patients with primary adrenal insufficiency: A cohort study. Eur J Endocrinol 2013; 168: 609-614
    CrossrefPubMedGoogle Scholar
  • 7 Arlt W, Allolio B. Adrenal insufficiency. Lancet 2003; 361: 1881-1893
    CrossrefPubMedGoogle Scholar
  • 8 Peacey SR, Guo CY, Robinson AM, Price A, Giles MA, Eastell R, Weetman AP. Glucocorticoid replacement therapy: are patients over treated and does it matter?. Clin Endocrinol 1997; 46: 255-261
    CrossrefPubMedGoogle Scholar
  • 9 Bondy K. Diseases of the adrenal cortex. Williams Textbook of Endocrinology. edition. 7th ed WB Saunders; 1985
    Google Scholar
  • 10 Filipsson H, Monson JP, Koltowska-Häggström M, Mattsson A, Johannsson G. The impact of glucocorticoid replacement regimens on metabolic outcome and comorbidity in hypopituitary patients. J Clin Endocrinol Metab 2006; 91: 3954-3961
    CrossrefPubMedGoogle Scholar
  • 11 Bergthorsdottir R, Leonsson-Zachrisson M, Odén A, Johannsson G. Premature mortality in patients with Addison’s disease: A population-based study. J Clin Endocrinol Metab 2006; 91: 4849-4853
    CrossrefPubMedGoogle Scholar
  • 12 Mason AS, Meade TW, Lee JA, Morris JN. Epidemiological and clinical picture of Addison’s disease. Lancet 1968; 2: 744-747
    PubMedGoogle Scholar
  • 13 Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet 383: 2152-2167
    PubMedGoogle Scholar
  • 14 Nieman LK. Treatment of adrenal insufficiency in adults. Up To Date 2013 On Line subscription
    PubMedGoogle Scholar
  • 15 Margolis DJ, Hoffstad O, Nafash J, Leonard CE, Freeman CP, Hennessy S, Wiebe DJ. Location, location, location: geographic clustering of lower-extremity amputation among Medicare beneficiaries with diabetes. Diabetes Care 2011; 34: 2363-2367
    CrossrefPubMedGoogle Scholar
  • 16 Sargen MR, Hoffstad O, Margolis DJ. Geographic variation in Medicare spending and mortality for diabetic patients with foot ulcers and amputations. J Diabetes Complicat 2013; 27: 128-133
    CrossrefPubMedGoogle Scholar
  • 17 Van den Bruel A, Francart J, Dubois C, Adam M, Vlayen J, De Schutter H, Stordeur S, Decallonne B. Regional variation in thyroid cancer incidence in Belgium is associated with variation in thyroid imaging and thyroid disease management. J Clin Endocrinol Metab 2013; 98: 4063-4071
    CrossrefPubMedGoogle Scholar
  • 18 Malhotra K, Baltrus P, Zhang S, McRoy L, Immergluck LC, Rust G. Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states. J Asthma 2014; 27: 1-9
    PubMedGoogle Scholar
  • 19 Volinn E, Diehr P, Ciol MA, Loeser JD. Why does geographic variation in health care practices matter? (And seven questions to ask in evaluating studies on geographic variation). Spine 1994; 19: 2092S-2100S
    CrossrefPubMedGoogle Scholar
  • 20 World Health Organisation . International Statistical Classification of Diseases and related Health Problems, 10th Revision (ICD-10). Geneva: WHO; 1992
    Google Scholar
  • 21 Willis AC, Vince FP. The prevalence of Addison's disease in Coventry, UK. Postgrad Med J 1997; 73: 286-288
    CrossrefPubMedGoogle Scholar
  • 22 Laureti S, Vecchi L, Santeusanio F, Falorni A. Is the prevalence of Addison’s disease underestimated?. J Clin Endocrin Metab 1999; 84: 1762
    PubMedGoogle Scholar
  • 23 Løvås K, Husebye ES. High prevalence and increasing incidence of Addison’s disease in western Norway. Clin Endocrinol (Oxf) 2002; 56: 787-791
    CrossrefPubMedGoogle Scholar
  • 24 Esteban NV, Loughlin T, Yergey AL, Zawadzki JK, Booth JD, Winterer JC, Loriaux DL. Daily cortisol production rate in man determined by stable isotope dilution/mass spectrometry. J Clin Endocrinol Metab 1991; 72: 39-45
    CrossrefPubMedGoogle Scholar
  • 25 Bleicken B, Hahner S, Loeffler M, Ventz M, Decker O, Allolio B, Quinkler M. Influence of hydrocortisone dosage scheme on health-related quality of life in patients with adrenal insufficiency. Clin Endocrinol (Oxf) 2010; 72: 297-304
    CrossrefPubMedGoogle Scholar
  • 26 Mah PM, Jenkins RC, Rostami-Hodjegan A, Newell-Price J, Doane A, Ibbotson V, Tucker GT, Ross RJ. Weight-related dosing, timing and monitoring hydrocortisone replacement therapy in patients with adrenal insufficiency. Clin Endocrinol (Oxf) 2004; 61: 367-375
    CrossrefPubMedGoogle Scholar
  • 27 Simon N, Castinetti F, Ouliac F, Lesavre N, Brue T, Oliver C. Pharmacokinetic evidence for suboptimal treatment of adrenal insufficiency with currently available hydrocortisone tablets. Clin Pharmacokinet 2010; 49: 455-463
    CrossrefPubMedGoogle Scholar
  • 28 Hahner S, Allolio B. Therapeutic management of adrenal insufficiency. Best Pract Res Clin Endocrinol Metab 2009; 23: 167-179
    CrossrefPubMedGoogle Scholar
  • 29 Forss M, Batcheller G, Skrtic S, Johannsson G. Current practice of glucocorticoid replacement therapy and patient-perceived health outcomes in adrenal insufficiency – a worldwide patient survey. BMC Endocr Disord 2012; 12: 8
    CrossrefPubMedGoogle Scholar
  • 30 Diederich S, Franzen NF, Bähr V, Oelkers W. Severe hyponatremia due to hypopituitarism with adrenal insufficiency: report on 28 cases. Eur J Endocrinol 2003; 148: 609-617
    CrossrefPubMedGoogle Scholar
  • 31 Arnold AC, Shibao C. Current concepts in orthostatic hypotension management. Curr Hypertens Rep 2013; 15: 304-312
    CrossrefPubMedGoogle Scholar
  • 32 Rushworth RL, Torpy DJ. A descriptive study of adrenal crises in adults with adrenal insufficiency: increased risk with age and in those with bacterial infections. BMC Endocr Disord 2014; 14: 79
    CrossrefPubMedGoogle Scholar