Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy.
Endocrine Disease Unit, University-Hospital of Padova, Padua, Italy.
J Endocrinol Invest. 2023 Jan;46(1):111-122. doi: 10.1007/s40618-022-01889-1. Epub 2022 Aug 10.
Fludrocortisone (FC) is the mineralocorticoid (MC) replacement treatment for patients with primary adrenal insufficiency (PAI).
To explore the dose of FC treatment and its relationship with glucocorticoid therapy, sodium, potassium, renin and clinical parameters.
Monocentric cohort.
Data of 193 patients with PAI (130 autoimmune) were collected during baseline (T0), intermediate (T1) and last follow-up visit (T2, respectively, after a mean of 38 and 72 months).
Utility of endocrine and clinical parameters to titrate FC dose.
FC dose (50-75 μg/daily) was stable in the follow-up in half patients. The MC activity of FC was dose-dependent: we observed a reduced but significant positive linear correlation between FC dose and sodium (r = 0.132) and negative linear correlation between FC and potassium (r = - 0.162) or renin (r = - 0.131, all p < 0.01). An overall reduction in the FC dose was observed at T2 in the group with longer follow-up (> 60 months, p < 0.05). Higher doses of FC were observed in patients with low-normal renin, especially in autoimmune PAI (86 vs 65 μg/daily, p < 0.05). On the contrary, reduced sodium and increased potassium levels were observed in patients with high renin at T2. The number of cardiovascular events (15 in the whole cohort) was similar in patients sorted by renin levels or FC dose.
Renin and electrolytes can indicate the MC activity of FC treatment: they should be routinely evaluated and used to titrate its dose that can be reduced in the long-term follow-up.
氟氢可的松（FC）是原发性肾上腺功能不全（PAI）患者的盐皮质激素（MC）替代治疗药物。
探索 FC 治疗剂量及其与糖皮质激素治疗、钠、钾、肾素和临床参数的关系。
单中心队列。
收集了 193 名 PAI 患者（130 名自身免疫性）的数据，分别在基线（T0）、中期（T1）和最后一次随访（T2）时进行采集，平均随访时间分别为 38 个月和 72 个月。
内分泌和临床参数对 FC 剂量滴定的效用。
在随访过程中，有一半患者的 FC 剂量（50-75μg/天）保持稳定。FC 的 MC 活性与剂量呈依赖性：我们观察到 FC 剂量与钠之间存在显著的负相关（r=0.132，p<0.01），与钾（r=-0.162）或肾素（r=-0.131，均 p<0.01）之间存在显著的正相关。在随访时间更长（>60 个月，p<0.05）的患者中，T2 时 FC 剂量总体减少。在低正常肾素的患者中，尤其是在自身免疫性 PAI 患者中，观察到更高剂量的 FC（86 vs 65μg/天，p<0.05）。相反，在 T2 时，肾素水平较高的患者出现了钠减少和钾增加的情况。整个队列中共有 15 例心血管事件，根据肾素水平或 FC 剂量分组的患者中，心血管事件的数量相似。
肾素和电解质可以提示 FC 治疗的 MC 活性：应常规评估并用于滴定其剂量，在长期随访中可以减少剂量。
