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Related Experiment Videos

Corticosteroid replacement therapy: twice or thrice daily?

R W Groves1, G C Toms, B J Houghton

  • 1Medical Unit (Endocrinology), London Hospital (Whitechapel).

Journal of the Royal Society of Medicine
|September 1, 1988
PubMed
Summary

Twice-daily hydrocortisone replacement leads to low cortisol levels in hypoadrenal patients. A thrice-daily regimen improved cortisol profiles and patient well-being, suggesting it should be the standard treatment.

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Area of Science:

  • Endocrinology
  • Pharmacology
  • Internal Medicine

Background:

  • Glucocorticoid replacement therapy is standard for hypoadrenalism.
  • Conventional twice-daily hydrocortisone dosing may result in suboptimal plasma cortisol levels, particularly in the afternoon.

Purpose of the Study:

  • To compare plasma cortisol profiles between twice-daily and thrice-daily hydrocortisone replacement regimens in hypoadrenal patients.
  • To assess the impact of different dosing frequencies on patient-reported well-being.

Main Methods:

  • A study involving 7 hypoadrenal patients.
  • Comparison of plasma cortisol levels at various time points throughout the day under two different hydrocortisone dosing schedules (twice vs. thrice daily).
  • Assessment of patient well-being using a visual analogue scale.

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Main Results:

  • Twice-daily hydrocortisone administration resulted in significantly low plasma cortisol levels at 16:00 and 18:00 hours.
  • Administering the same total daily dose thrice daily eliminated these afternoon cortisol dips.
  • Patient well-being scores correlated significantly with plasma cortisol levels.
  • Five out of seven patients preferred the thrice-daily regimen.

Conclusions:

  • Thrice-daily hydrocortisone replacement therapy offers improved physiological cortisol profiles compared to twice-daily dosing.
  • This optimized dosing schedule enhances patient well-being and is preferred by most patients.
  • Routine adoption of thrice-daily glucocorticoid replacement therapy is recommended for hypoadrenalism.