Jeffcoate W
Department of Diabetes and Endocrinology, City Hospital, Nottingham, UK.
Ann Clin Biochem. 1999 Mar;36 ( Pt 2):151-7. doi: 10.1177/000456329903600203.
Recent work has taught us that our conventional approach to corticosteroid replacement therapy requires review. Specifically, the doses of hydrocortisone we have used are probably too high for the majority, and should ideally be administered in three or more doses through the day. Nevertheless, there is not much hard evidence that excessive glucocorticoid replacement per se will lead to adverse effects such as osteoporosis, even though it may exacerbate any tendency in those who are predisposed to it for other reasons. As such, there is no compelling need for using determinations of either UFC excretion or of the serum cortisol profile in the routine management of patients on replacement therapy. Nevertheless, such measures may be considered in those thought to be at particular risk of osteoporosis, and in whom it is felt that special effort should be made to ensure that they are receiving the minimum dose possible. In such circumstances, a cortisol day curve is likely to be of more value than measurement of UFC.
近期的研究让我们认识到，我们传统的皮质类固醇替代疗法需要重新审视。具体而言，我们使用的氢化可的松剂量对大多数人来说可能过高，理想情况下应分三次或更多次在一天内给药。然而，并没有确凿的证据表明，过量的糖皮质激素替代治疗本身会导致骨质疏松等不良反应，尽管它可能会加剧那些因其他原因易患骨质疏松症的人的患病倾向。因此，在接受替代治疗的患者的常规管理中，没有迫切需要使用尿游离皮质醇排泄量或血清皮质醇谱测定。不过，对于那些被认为有特别高的骨质疏松风险且认为应特别努力确保他们接受尽可能低剂量治疗的患者，可以考虑采取这些措施。在这种情况下，皮质醇日曲线可能比尿游离皮质醇测量更有价值。
