Reznik Yves
CHU Côte de Nacre, service d'endocrinologie, diabétologie et maladies métaboliques, avenue de la Côte de Nacre, 14033 Caen cedex, France.
Presse Med. 2014 Apr;43(4 Pt 1):438-43. doi: 10.1016/j.lpm.2014.02.003. Epub 2014 Mar 11.
Quality of life remains altered in the adrenal insufficient patient treated by hydrocortisone and fludrocortisone. Due to its pharmacokinetics properties, hydrocortisone requires 2 to 3 daily doses - including a morning intake of 2/3 or half of the daily dose respectively - while fludrocortisone requires a once morning daily dose. Titration of hydrocortisone and fludrocortisone relies on the clinical symptoms of over- or under-replacement together with biochemical indexes such as plasma sodium, potassium and renin. DHEA replacement may improve quality of life and mood and may increase lean body mass and bone mineral density, especially in women with adrenal insufficiency. The new slow release hydrocortisone formulations may help reproduce a more physiological cortisol plasma profile and thus reduce the impact of over-replacement on cardiovascular risk factors and glucose metabolism. Acute adrenal insufficiency is a life-threatening complication of glucocorticoid and mineralocorticoid under-replacement, which may be prevented by educational programs towards the adrenal insufficient patient.
接受氢化可的松和氟氢可的松治疗的肾上腺功能不全患者的生活质量仍会受到影响。由于其药代动力学特性，氢化可的松需要每日服用2至3次——包括分别在早晨服用2/3或一半的日剂量——而氟氢可的松只需每天早晨服用一次。氢化可的松和氟氢可的松的剂量调整依赖于替代过量或不足的临床症状以及血浆钠、钾和肾素等生化指标。补充脱氢表雄酮（DHEA）可能会改善生活质量和情绪，并可能增加瘦体重和骨矿物质密度，尤其是对于肾上腺功能不全的女性。新型缓释氢化可的松制剂可能有助于重现更符合生理的皮质醇血浆曲线，从而降低替代过量对心血管危险因素和糖代谢的影响。急性肾上腺功能不全是糖皮质激素和盐皮质激素替代不足的一种危及生命的并发症，可通过对肾上腺功能不全患者开展教育项目来预防。
