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Is physiological glucocorticoid replacement important in children?

John Porter1, Joanne Blair2, Richard J Ross1,3

  • 1Diurnal Ltd, Cardiff, UK.

Archives of Disease in Childhood
|September 2, 2016
PubMed

Insights

Physiological glucocorticoid replacement aims to mimic natural cortisol rhythms. New hydrocortisone formulations may improve fatigue and health outcomes in adrenal insufficiency patients, particularly children.

Area of Science:

  • Endocrinology
  • Chronobiology
  • Pharmacology

Background:

  • Cortisol exhibits a distinct circadian rhythm, crucial for metabolic regulation.
  • Disruption of this rhythm is linked to fatigue, obesity, and diabetes.
  • Current hydrocortisone replacement therapy for adrenal insufficiency is often unphysiological.

Purpose of the Study:

  • To review evidence on physiological glucocorticoid replacement therapies.
  • To focus on the relevance of these new therapies in pediatric patients.
  • To address the limitations of current glucocorticoid replacement.

Main Methods:

  • Literature review of studies on glucocorticoid replacement.
  • Analysis of novel drug delivery systems for hydrocortisone.
  • Focus on formulations designed to mimic cortisol's circadian profile.

Main Results:

  • Current hydrocortisone therapy results in unphysiological cortisol levels.
  • Patients with adrenal insufficiency report fatigue and poor quality of life.
  • New technologies like subcutaneous pumps, Plenadren, and Chronocort aim for physiological replacement.

Conclusions:

  • Physiological glucocorticoid replacement is essential for managing adrenal insufficiency.
  • Novel formulations hold promise for improving patient outcomes, including in pediatrics.
  • Further research is needed to optimize these therapies for long-term health benefits.

Keywords:
Adrenal InsufficiencyCircadian rhythmsCongenital Adrenal HyperplasiaCortisolGlucocorticoid

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