Løvås Kristian, Husebye Eystein S
Division of Endocrinology, Institute of Medicine, University of Bergen, Norway.
Eur J Endocrinol. 2007 Jul;157(1):109-12. doi: 10.1530/EJE-07-0052.
The conventional replacement therapy in Addison's disease (AD) does not restore the normal diurnal cortisol rhythm. We explored the feasibility and safety of continuous s.c. hydrocortisone infusion (CSHI) as a novel mode of glucocorticoid replacement therapy.
Seven patients with AD were treated with CSHI in an open-labelled clinical study for up to three months. Adequacy of glucocorticoid replacement was assessed by 24 h blood and saliva sampling in one patient and by salivary cortisol day curves in six outpatients. Subjective health status was monitored by the Short Form-36 questionnaire.
CSHI re-established the circadian variation and normal levels of cortisol in the patients, with minor day-to-day variation. Most of the patients could reduce their glucocorticoid dose considerably without adverse reactions. The treatment was well tolerated and positively evaluated by the patients.
CSHI is technically feasible and safe in patients with AD. A daily dose of approximately 10 mg/m(2) body surface area/day restores the circadian variation and normal levels of salivary cortisol in most patients, which is close to the estimated daily requirement. We hypothesise that selected patients will benefit from restoration of the circadian cortisol rhythm.
艾迪生病（AD）的传统替代疗法无法恢复正常的皮质醇昼夜节律。我们探讨了皮下持续输注氢化可的松（CSHI）作为一种新型糖皮质激素替代疗法的可行性和安全性。
在一项开放标签的临床研究中，对7例AD患者采用CSHI治疗长达3个月。通过对1例患者进行24小时血液和唾液采样以及对6例门诊患者进行唾液皮质醇日曲线评估糖皮质激素替代的充分性。通过简短健康调查问卷（Short Form-36）监测主观健康状况。
CSHI使患者体内皮质醇的昼夜变化和水平恢复正常，且每日变化较小。大多数患者能够大幅减少糖皮质激素剂量而无不良反应。该治疗耐受性良好，患者给予积极评价。
CSHI在AD患者中技术上可行且安全。每日约10mg/m²体表面积的剂量可使大多数患者的唾液皮质醇昼夜变化和水平恢复正常，这接近估计的每日需求量。我们推测特定患者将从昼夜皮质醇节律的恢复中获益。
