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Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency
BACKGROUND: Dual-release hydrocortisone (DR-HC) improves metabolism in patients with adrenal insufficiency. The aims of this study were to compare the cardiovascular and metabolic effects of conventional glucocorticoids (GCs) vs. DR-HC and of high vs. low doses of GCs, after 48 months of observation...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Bioscientifica Ltd
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599082/ https://www.ncbi.nlm.nih.gov/pubmed/31252397 http://dx.doi.org/10.1530/EC-19-0176 |
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author | Guarnotta, V Di Stefano, C Santoro, A Ciresi, A Coppola, A Giordano, C |
author_facet | Guarnotta, V Di Stefano, C Santoro, A Ciresi, A Coppola, A Giordano, C |
author_sort | Guarnotta, V |
collection | PubMed |
description | BACKGROUND: Dual-release hydrocortisone (DR-HC) improves metabolism in patients with adrenal insufficiency. The aims of this study were to compare the cardiovascular and metabolic effects of conventional glucocorticoids (GCs) vs. DR-HC and of high vs. low doses of GCs, after 48 months of observation. METHODS: We selected 27 patients on hydrocortisone (mean dose 17.5 ± 4.2 mg/day) and 20 patients on cortisone acetate (mean dose 37.5 ± 12.1 mg/day) who maintained this treatment (group A) and 53 patients switched to DR-HC (mean dose 22 ± 4.8 mg/day) (group B). At baseline and after 48 months, clinical and metabolic parameters and Framingham Risk Score (FRS) were obtained. RESULTS: After 48 months, patients in group A had a significant increase from baseline in BMI (P < 0.001), waist circumference (P = 0.001), systolic blood pressure (P = 0.001), LDL cholesterol (P = 0.018), HbA1c (P = 0.020) and FRS (P = 0.002). By contrast, patients in group B had a significant decrease in BMI (P = 0.002), waist circumference (P = 0.015), diastolic blood pressure (P = 0.031), total (P = 0.006) and LDL cholesterol (P = 0.005), HbA1c (P < 0.001) and FRS (P = 0.015) compared to baseline. No significant differences between high and low doses of both conventional GCs and DR-HC were observed. CONCLUSIONS: DR-HC is associated with an improvement of metabolic parameters and cardiovascular risk compared to conventional GCs, which are associated with a worsening of these parameters, regardless of the dose used. |
format | Online Article Text |
id | pubmed-6599082 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Bioscientifica Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-65990822019-07-03 Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency Guarnotta, V Di Stefano, C Santoro, A Ciresi, A Coppola, A Giordano, C Endocr Connect Research BACKGROUND: Dual-release hydrocortisone (DR-HC) improves metabolism in patients with adrenal insufficiency. The aims of this study were to compare the cardiovascular and metabolic effects of conventional glucocorticoids (GCs) vs. DR-HC and of high vs. low doses of GCs, after 48 months of observation. METHODS: We selected 27 patients on hydrocortisone (mean dose 17.5 ± 4.2 mg/day) and 20 patients on cortisone acetate (mean dose 37.5 ± 12.1 mg/day) who maintained this treatment (group A) and 53 patients switched to DR-HC (mean dose 22 ± 4.8 mg/day) (group B). At baseline and after 48 months, clinical and metabolic parameters and Framingham Risk Score (FRS) were obtained. RESULTS: After 48 months, patients in group A had a significant increase from baseline in BMI (P < 0.001), waist circumference (P = 0.001), systolic blood pressure (P = 0.001), LDL cholesterol (P = 0.018), HbA1c (P = 0.020) and FRS (P = 0.002). By contrast, patients in group B had a significant decrease in BMI (P = 0.002), waist circumference (P = 0.015), diastolic blood pressure (P = 0.031), total (P = 0.006) and LDL cholesterol (P = 0.005), HbA1c (P < 0.001) and FRS (P = 0.015) compared to baseline. No significant differences between high and low doses of both conventional GCs and DR-HC were observed. CONCLUSIONS: DR-HC is associated with an improvement of metabolic parameters and cardiovascular risk compared to conventional GCs, which are associated with a worsening of these parameters, regardless of the dose used. Bioscientifica Ltd 2019-06-04 /pmc/articles/PMC6599082/ /pubmed/31252397 http://dx.doi.org/10.1530/EC-19-0176 Text en © 2019 The authors http://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License. (http://creativecommons.org/licenses/by/4.0/) |
spellingShingle | Research Guarnotta, V Di Stefano, C Santoro, A Ciresi, A Coppola, A Giordano, C Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency |
title | Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency |
title_full | Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency |
title_fullStr | Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency |
title_full_unstemmed | Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency |
title_short | Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency |
title_sort | dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599082/ https://www.ncbi.nlm.nih.gov/pubmed/31252397 http://dx.doi.org/10.1530/EC-19-0176 |
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