Related Experiment Video
Updated: May 3, 2026
Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss
Published on: January 25, 2016
Continuous subcutaneous hydrocortisone infusion versus oral hydrocortisone replacement for treatment of addison's
Marianne Oksnes1, Sigridur Björnsdottir, Magnus Isaksson
1Department of Clinical Science (M.Ø., P.M., K.T., K.L., E.S.H.), University of Bergen, N-5009 Bergen, Norway; Department of Medicine (M.Ø., K.L., E.S.H.) and Centre for Clinical Research, Haukeland University Hospital, N-5021 Bergen, Norway (R.M.N.); Department of Molecular Medicine and Surgery (S.Bj., A.-L.H., S.Be.), Karolinska Institutet, SE-171 77 Stockholm, Sweden; Departments of Medical Sciences (M.I., S.B., O.K.) and Neuroscience and Psychiatry (J.-E.B.), Uppsala University, SE-751 05 Uppsala, Sweden; and Department of Medicine (S.C.), Stavanger University Hospital, N-4068 Stavanger, Norway.
Context:
Conventional glucocorticoid replacement therapy fails to mimic the physiological cortisol rhythm, which may have implications for morbidity and mortality in patients with Addison's disease.
Objective:
The objective of the study was to compare the effects of continuous sc hydrocortisone infusion (CSHI) with conventional oral hydrocortisone (OHC) replacement therapy.
Design, Patients, And Interventions:
This was a prospective crossover, randomized, multicenter clinical trial comparing 3 months of treatment with thrice-daily OHC vs CSHI. From Norway and Sweden, 33 patients were enrolled from registries and clinics. All patients were assessed at baseline and after 8 and 12 weeks in each treatment arm.
Main Outcome Measures:
The morning ACTH level was the primary outcome measure. Secondary outcome measures were effects on metabolism, health-related quality of life (HRQoL), sleep, and safety.
Results:
CSHI yielded normalization of morning ACTH and cortisol levels, and 24-hour salivary cortisol curves resembled the normal circadian variation. Urinary concentrations of glucocorticoid metabolites displayed a normal pattern with CSHI but were clearly altered with OHC. Several HRQoL indices in the vitality domain improved over time with CSHI. No benefit was found for either treatments for any subjective (Pittsburgh Sleep Quality Index questionnaire) or objective (actigraphy) sleep parameters.
Conclusion:
CSHI safely brought ACTH and cortisol toward normal circadian levels without adversely affecting glucocorticoid metabolism in the way that OHC did. Positive effects on HRQoL were noted with CSHI, indicating that physiological glucocorticoid replacement therapy may be beneficial and that CSHI might become a treatment option for patients poorly controlled on conventional therapy.
Related Concept Videos
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
01:26Cushing Syndrome I: Introduction
01:19Cushing Syndrome II: Pathophysiology
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:27Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
01:26COPD: Management Using Bronchodilators and Corticosteroids