每日糖皮质激素替代剂量在肾上腺功能不全中的应用：一篇迷你综述。
Daily Glucocorticoid Replacement Dose in Adrenal Insufficiency, a Mini Review.
机构信息
Division of Endocrinology and Metabolism, and Neag Comprehensive Cancer Center, University of Connecticut (UCONN) Health, Farmington, CT, United States.
出版信息
Front Endocrinol (Lausanne). 2022 Jun 29;13:897211. doi: 10.3389/fendo.2022.897211. eCollection 2022.
Abstract
The Endocrine Society Guidelines and recent reviews of adrenal insufficiency (AI) recommend a daily glucocorticoid replacement dose of 15 to 25 mg with a midpoint of 20 mg of hydrocortisone (HC) (alternatively 3 to 5 mg prednisolone) in divided doses in otherwise healthy individuals with AI. In contrast, a daily glucocorticoid replacement dose of 4.3 to 26 mg/d HC with a midpoint of 15 mg/d is predicted from current measurements of daily cortisol production rates and oral HC bioavailability. The higher HC doses recommended in the current guidelines may result in glucocorticoid overtreatment of some AI patients and associated long-term adverse outcomes. A titration method for determination of the individual patient's daily glucocorticoid replacement dose and the impact of lower doses are reviewed. Future related research questions are identified.
摘要
内分泌学会指南以及最近对肾上腺功能不全 (AI) 的评论建议，对于无其他健康问题的 AI 患者，采用每日糖皮质激素替代治疗，剂量为 15 至 25mg，氢化可的松（HC）中点剂量为 20mg（或等效剂量为 3 至 5mg 泼尼松龙），分剂量服用。相比之下，根据目前对每日皮质醇生成率和口服 HC 生物利用度的测量，预测每日糖皮质激素替代剂量为 4.3 至 26mg/d HC，中点剂量为 15mg/d。目前指南中推荐的更高剂量的 HC 可能导致某些 AI 患者出现糖皮质激素过度治疗，并伴有长期不良后果。本文回顾了确定个体患者每日糖皮质激素替代剂量的滴定方法以及低剂量的影响。并确定了未来相关的研究问题。
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