Li Voon Chong J S, Sen J, Johnson Z, Kyle G, MacFarlane I A
Department of Endocrinology, University Hospital Aintree, Liverpool, UK.
Clin Endocrinol (Oxf). 2001 Feb;54(2):267-71. doi: 10.1046/j.1365-2265.2001.01200.x.
It has been suggested that the variation of intraocular pressure (IOP) during the day follows the diurnal variation of serum cortisol. There is also a higher risk of ocular hypertension and glaucoma in patients taking excessive oral steroid treatment. We assessed whether different replacement doses of hydrocortisone (HC) influenced IOP.
Seventeen patients (six Addison's disease, 11 hypopituitarism; seven males) aged 24-58 years mean 42.7 years and 20 control subjects (nine males) aged 20--59 years mean 38.7 years were studied. On the first visit, the 17 patients had been taking HC replacement doses, 20 mg morning and 10 mg afternoon. Serum cortisol and IOP in both eyes (Goldmann applanation tonometer) were measured at 0900, 1100, 1300, 1500, 1700 hours with HC 20 mg taken after the 0900 h assessment. The dose of HC was then reduced to 10 mg morning and 10 mg afternoon for 1 week and the measurements were repeated in 16 patients, with HC 10 mg taken at 0900 h.
In the patients the peak serum cortisol occurred at 1100 h after the 0900 h HC dose. Cortisol levels were significantly higher at 1100, 1300, 1500 and 1700 h after taking 20 mg compared to 10 mg HC. The mean (SEM) IOP (mmHg) was significantly higher after 20 mg HC compared with 10 mg HC at 1300 h: 14.7(0.6) v 13.1(0.6) (P = 0.004) and at 1500 h: 14.4(0.6) v 13.1(0.5) (P = 0.04). The total mean (SEM) daily IOP score was significantly higher after 20 mg HC compared with 10 mg HC: 14.5(0.3) v 13.5(0.3) (P = 0.0002). The total mean (SEM) daily IOP score after the 20 mg HC dose compared with the control subjects was: 14.5(0.3) v 13.7(0.3) (P = 0.08).
Intraocular pressures during the day are influenced by the morning hydrocortisone replacement dosage with significantly higher intraocular pressure levels in the early afternoon following 20 mg compared with 10 mg. A morning hydrocortisone dose of 10 mg leads to a more physiological intraocular pressure profile during the day. These data support the view that a daily replacement dose of 30 mg hydrocortisone may be excessive.
有人提出，眼压（IOP）在一天中的变化遵循血清皮质醇的昼夜变化规律。接受过量口服类固醇治疗的患者患高眼压和青光眼的风险也更高。我们评估了不同替代剂量的氢化可的松（HC）是否会影响眼压。
研究了17例年龄在24 - 58岁（平均42.7岁）的患者（6例艾迪生病，11例垂体功能减退；7例男性）和20例年龄在20 - 59岁（平均38.7岁）的对照受试者（9例男性）。首次就诊时，17例患者服用的HC替代剂量为上午20 mg，下午10 mg。在09:00、11:00、13:00、15:00、17:00测量双眼的血清皮质醇和眼压（Goldmann压平眼压计），09:00评估后服用20 mg HC。然后将HC剂量减至上午10 mg，下午10 mg，持续1周，16例患者重复测量，09:00服用10 mg HC。
在患者中，血清皮质醇峰值出现在09:00服用HC剂量后的11:00。服用20 mg HC后，11:00、13:00、15:00和17:00的皮质醇水平显著高于服用10 mg HC时。与10 mg HC相比，20 mg HC后13:00时的平均（SEM）眼压（mmHg）显著更高：14.7(0.6) 对 13.1(0.6)（P = 0.004），15:00时：14.4(0.6) 对 13.1(0.5)（P = 0.04）。与10 mg HC相比，20 mg HC后的每日总平均（SEM）眼压评分显著更高：14.5(0.3) 对 13.5(0.3)（P = 0.0002）。与对照受试者相比，20 mg HC剂量后的每日总平均（SEM）眼压评分为：14.5(0.3) 对 13.7(0.3)（P = 0.08）。
一天中的眼压受早晨氢化可的松替代剂量的影响，与10 mg相比，20 mg后下午早些时候的眼压水平显著更高。早晨10 mg的氢化可的松剂量导致一天中眼压分布更接近生理状态。这些数据支持每日30 mg氢化可的松替代剂量可能过高的观点。
