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Comparison between two different therapeutic methods with hydrocortisone in patients with congenital adrenal hyperplasia
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M RazaghiAzar   |
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Abstract: (31313 Views) |
| Abstract: Congenital adrenal hyperplasia is due to enzymatic deficiencies in the pathway of steroid hormone synthesis. In order to provide normal growth and ideal height and prevent the complications due to inappropriate therapy in these patients, delicate points should be considered. Adrenocorticotropic hormone (ACTH) is mainly secreted during the night (2 to 9 a.m) and it seems that steroid administration during the night has more inhibitory effect on ACTH secretion. On the other hand, patient’s compliance is improved by lower divided drug dosage. We evaluated two methods of hydrocortisone administration in 67 patients (43 girls, 24 boys) during a 4-year period. At first patients were treated with 16±5mg/m2 of daily hydrocortisone in 3 divided doses with the largest dose in the morning over 20.8±5.6 months (old method). Then the same patients were treated with 15±3mg/m2 of daily hydrocortisone in two divided doses with the larger dose in the night over 20.6±5.7 months (new method). Serum 17OH-progesterone was measured every 3-6 months and patients were divided into two groups according to the level of 17-OHP (<10ng/ml or >10ng/ml) and analysed with Chi-square. Mean 17-OHP serum level was compared between these two methods. At the end of each therapeutic method, SDS for height, GVI (growth velocity of patients / normal growth velocity for age X 100), BMI (weight / (height)2), and WHI (patient’s weight / mean weight according to age height index X 100) were measured and analyzed using paired t test. There was no significant difference in mean SDS for height at the end of treatment with old and new methods (-0.38 ± 1.5 and –0.4 ± 1.4, respectively). There was also no significant difference in GVI between these 2 methods (89 ± 32 and 94 ± 34 in old and new methods, respectively). There was significant difference in BMI between old and new methods (19 ± 4.6 and 19.89 ± 5.3kg/m2, respectively) (P<0.001). WHI at the end of treatment with old and new methods were 116.7±23 and 119.8 ± 27, respectively, without any significant difference (P=NS). Serum 17OHP concentration was lower than 10ng/ml in 65.4% and 82.7% of patients in old and new methods, respectively, and the difference was statistically significant (P=0.003). Mean 17OHP level in new therapeutic method was significantly lower than that in old method (6.9±13 vs. 18.9±29ng/ml, P = 0.003). In both methods, patients didn’t complain of fatigue. In new therapeutic method, there was not any increase in hirsutism, virilism and skin pigmentation, and even improvement was observed in skin pigmentation. The findings showed that growth velocity doesn’t show significant difference between these two methods. There was an increase in body mass index (BMI) in new therapeutic method but no significant increase was observed in height-weight index. In new therapeutic method, serum level of 17OHP is better controlled and patients have better therapeutic compliance. |
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| Keywords: Congenital adrenal hyperplasia, Hydrocortisone, ACTH |
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Full-Text [PDF 324 kb]
(10422 Downloads)
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Type of Study: Original |
Subject:
Endocrinology
Received: 2006/11/14 | Published: 2000/06/15
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