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Continuous subcutaneous hydrocortisone infusion in Addison's disease.
Kristian Løvås1, Eystein S Husebye
1Division of Endocrinology, Institute of Medicine, University of Bergen, Norway. kristian.lovas@med.uib.no
European Journal of Endocrinology
|July 5, 2007
Summary
Continuous subcutaneous hydrocortisone infusion (CSHI) offers a safe and feasible way to restore normal cortisol levels in Addison's disease (AD) patients. This novel therapy improves circadian rhythm and patient well-being.
Area of Science:
- Endocrinology
- Pharmacology
- Clinical Medicine
Background:
- Conventional Addison's disease (AD) treatment fails to replicate the natural diurnal cortisol rhythm.
- Glucocorticoid replacement therapy in AD requires optimization for physiological relevance.
Purpose of the Study:
- To assess the feasibility and safety of continuous subcutaneous hydrocortisone infusion (CSHI) for AD.
- To evaluate CSHI's efficacy in restoring cortisol circadian variation and physiological levels.
Main Methods:
- An open-label study involving seven AD patients treated with CSHI for up to three months.
- Assessment of glucocorticoid replacement adequacy through 24-hour blood and salivary cortisol sampling.
- Monitoring of subjective health status using the Short Form-36 questionnaire.
Main Results:
- CSHI successfully re-established circadian cortisol variation and normalized levels with minimal fluctuation.
- Patients often achieved dose reduction without adverse effects, indicating improved glucocorticoid replacement.
- The treatment was well-tolerated and positively perceived by the majority of patients.
Conclusions:
- Continuous subcutaneous hydrocortisone infusion (CSHI) is a technically feasible and safe therapeutic option for Addison's disease.
- A daily dose of approximately 10 mg/m(2) body surface area effectively restores circadian cortisol rhythm in most patients.
- Restoration of the circadian cortisol rhythm via CSHI is hypothesized to benefit selected Addison's disease patients.
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