Fichna Marta, Gryczyńska Maria, Sowińska Anna, Sowiński Jerzy
Klinika Endokrynologii, Przemiany Materii i Chorób Wewnetrznych, Uniwersytet Medyczny im. K. Marcinkowskiego w Poznaniu.
Przegl Lek. 2011;68(2):96-102.
Primary adrenocortical insufficiency (Addison's disease) requires lifelong steroid substitution. Although the patients are both at risk of under-replacement and excessive glucocorticoid exposure, there is no consensus on monitoring this therapy. The aim of the study was to assess the substitution therapy in Addison's disease in regard to metabolic balance, glycaemic effects and bone mineral density. Seventy two subjects with primary adrenal insufficiency (52 women, 20 men) were evaluated. Mean disease duration was 15.6 years. All patients were supplemented with hydrocortisone (10-60 mg/day), 45 also used fludrocortisone, and 8 - dehydroepiandrosterone. The patients underwent medical examination, assessment of glycaemia and electrolyte parameters, and hormonal analyses. Bone mineral density was evaluated in 65 individuals. Mean blood pressure in patients was 117/74 mmHg and positively correlated with age (p < 0.001). No correlation was found between the daily hydrocortisone dose and blood pressure nor electrolyte parameters. Mean morning serum cortisol before hydrocortisone administration was 27 +/- 42 nmol/l, 2 hours later 904 +/- 263 nmol/l, 222 +/- 226 nmol/l before the afternoon dose, and 219 +/- 192 nmol/l around 22.00. Mean 24h urinary cortisol excretion was 521.5 +/- 387 nmol, and morning plasma ACTH was 398.9 +/- 423 pg/ml. Fasting serum glucose was 83.6 +/- 12.6 mg/dl. Fasting glycaemia and insulinaemia did not correlate with hydrocortisone dose but did present a positive correlation with body mass and age. Sixteen patients were diagnosed with osteoporosis in the lumbar spine, and 6 women--in femoral neck. Bone mineral density correlated positively with serum DHEA-S, and negatively with the patient's age, duration of the Addison's disease and total steroid dose administered during the therapy. In conclusion, the steroid substitution in Addison's disease requires individually tailored dosage and adequate monitoring. The factors which may potentially contribute to the development of adverse effects of the glucocorticoid over-supplementation are age, duration of the Addison's disease and total administered steroid dose.
原发性肾上腺皮质功能减退症（艾迪生病）需要终身使用类固醇替代治疗。尽管患者存在替代不足和糖皮质激素暴露过量的风险，但对于监测这种治疗方法尚无共识。本研究的目的是评估艾迪生病的替代治疗在代谢平衡、血糖效应和骨密度方面的情况。对72例原发性肾上腺功能不全患者（52例女性，20例男性）进行了评估。平均病程为15.6年。所有患者均补充氢化可的松（10 - 60毫克/天），45例还使用了氟氢可的松，8例使用了脱氢表雄酮。患者接受了体格检查、血糖和电解质参数评估以及激素分析。对65例个体进行了骨密度评估。患者的平均血压为117/74毫米汞柱，且与年龄呈正相关（p < 0.001）。未发现每日氢化可的松剂量与血压及电解质参数之间存在相关性。氢化可的松给药前早晨血清皮质醇平均水平为27±42纳摩尔/升，给药2小时后为904±263纳摩尔/升，下午给药前为222±226纳摩尔/升，晚上22:00左右为219±192纳摩尔/升。24小时尿皮质醇排泄平均水平为521.5±387纳摩尔，早晨血浆促肾上腺皮质激素水平为398.9±423皮克/毫升。空腹血清葡萄糖为83.6±12.6毫克/分升。空腹血糖和胰岛素血症与氢化可的松剂量无关，但与体重和年龄呈正相关。16例患者被诊断为腰椎骨质疏松症，6例女性为股骨颈骨质疏松症。骨密度与血清硫酸脱氢表雄酮呈正相关，与患者年龄、艾迪生病病程以及治疗期间给予的总类固醇剂量呈负相关。总之，艾迪生病的类固醇替代治疗需要个体化调整剂量并进行充分监测。可能导致糖皮质激素补充过量产生不良反应的因素包括年龄、艾迪生病病程和给予的总类固醇剂量。
