Division of Pediatric Endocrinology, Department of Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA.
Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, USA.
Horm Res Paediatr. 2022;95(1):62-67. doi: 10.1159/000523808. Epub 2022 Feb 25.
Glucocorticoid therapy in children with congenital adrenal hyperplasia (CAH) must be finely balanced between optimizing adrenal control and minimizing side effects. Twice (BID) rather than three times daily (TID) hydrocortisone may provide similar adrenal control and reduce metabolic risk. We compared BID and TID regimens with respect to adrenal control, growth, and metabolic effects.
A retrospective chart review (n = 128 visits, 36 individual patients) of prepubertal children with classical CAH was conducted at a tertiary care center between March 2007 and February 2020. Adrenal control, growth, and metabolic data were extracted in those taking hydrocortisone BID versus TID. Univariate generalized estimating equations models were performed to analyze the effect of dose frequency on outcomes of interest.
Overall, we found no difference in adrenal control (8% vs. 18% poor control) or testosterone levels (9.65 ng/dL vs. 7.62 ng/dL) between the BID versus TID groups. We detected no difference in growth velocity (6.86 vs. 6.32 cm/year) or bone age advancement (11.3 vs. 5.91 months) between the groups. There was no difference in daily steroid dose (12.1 vs. 11.7 mg/m2/day), BMI Z-score (0.43 vs. 0.31), or systolic blood pressure percentile (65.5 vs. 61.7).
BID dosing provides similar adrenal control and does not appear to impact growth or bone age advancement. On the other hand, TID dosing does not appear to increase the metabolic side effect profile in this age-group. Dosing should be patient-centered with individualized consideration.
儿童先天性肾上腺皮质增生症（CAH）的糖皮质激素治疗必须在优化肾上腺控制和最小化副作用之间取得精细平衡。每日两次（BID）而非每日三次（TID）给予氢化可的松可能提供相似的肾上腺控制并降低代谢风险。我们比较了 BID 和 TID 方案在肾上腺控制、生长和代谢效果方面的差异。
在 2007 年 3 月至 2020 年 2 月期间，我们对一家三级护理中心的青春期前经典 CAH 患儿进行了回顾性图表审查（n = 128 次就诊，36 名个体患者）。在接受 BID 或 TID 氢化可的松治疗的患者中提取了肾上腺控制、生长和代谢数据。使用单变量广义估计方程模型分析剂量频率对感兴趣结局的影响。
总体而言，我们发现 BID 组与 TID 组之间的肾上腺控制（8%与 18%控制不良）或睾酮水平（9.65ng/dL 与 7.62ng/dL）无差异。我们未发现两组间生长速度（6.86cm/年与 6.32cm/年）或骨龄进展（11.3 个月与 5.91 个月）的差异。两组间的每日激素剂量（12.1mg/m2/天与 11.7mg/m2/天）、BMI Z 评分（0.43 与 0.31）或收缩压百分位数（65.5%与 61.7%）无差异。
BID 给药提供了相似的肾上腺控制，似乎不会影响生长或骨龄进展。另一方面，在该年龄组中，TID 给药似乎不会增加代谢副作用谱。应根据患者的具体情况个体化考虑剂量。
