- Determination of Glucocorticoid Replacement Therapy and Adequate Maintenance Dose in Patients with Secondary Adrenal Insufficiency.
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Sang Wan Kim, Hye Seung Jung, Seong Hee Kwon, Do Joon Park, Chan Soo Shin, Kyung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
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J Korean Endocr Soc. 2003;18(5):456-464. Published online October 1, 2003
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 Abstract
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Determination of the adequate dose of glucocorticoid replacement therapy, in patients with secondary adrenal insufficiency, is of great importance to avoid the consequences of under or over treatment. The aims of this study were: 1) to assess the value of adrenal cortical function tests in determining whether glucocorticoid replacement should be given, and 2) to investigate the adequate maintenance dose of glucocorticoid in patients with secondary adrenal insufficiency. METHODS: Forty patients, with secondary adrenal insufficiency, confirmed by the insulin-induced hypoglycemia test (IHT), were studied. All subjects underwent basal serum cortisol measurement, IHT and 250 g rapid ACTH stimulation tests (AST). The clinical usefulness of these tests, for the determination of glucocorticoid replacement therapy, was evaluated in patients with secondary adrenal insufficiency. 26 of the 40 patients had received prednisolone (Pd) (5 mg per day) replacement due to symptoms from adrenal insufficiency. The dose of Pd was serially changed from 5 to 3.75, and then to 6.25 mg per day, every 3 month. The measured lipid parameters, serum osteocalcin and urinary N-telopeptide were measured and the quality of life evaluated by the administration of an Addisonian questionnaire, both before and after the dose changes. RESULTS: 1) For all tests, cut-offs were selected that would provide adequate specificity and sensitivity. When the cut-offs were set to provide 95% specificity, the corresponding sensitivitycut-off values, obtained with basal serum cortisol, peak serum cortisol in IHT and AST were: 88.4% <5 microgram/dL, 80.7% <11 microgram/dL and 76.9% <16 microgram/dL. 2) The urinary type I collagen N-telopeptide, total cholesterol, HDL- and LDL-cholesterol levels were significantly increased, and the serum osteocalcin levels significantly decreased when the daily dose of Pd was increased to 6.25 from 3.75 or 5 mg. The LDL-cholesterol levels especially, were significantly increased, even though the change in the Pd from 3.75 to 5 mg per day was subtle. CONCLUSION: The basal cortisol levels, HPA axis tests and the symptoms of patients may be helpful to determine whether prednisolone replacement therapy should be given. It is suggest that an adequate dose of glucocorticoid replacement therapy should be not exceed Pd 5mg per day, so as not to have adverse effects on the bone and lipid metabolisms.
- Hypertensive Complications in Patients with Primary Aldosteronism.
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Seong Hee Kwon, Yeong Min Cho, Heoung Kyu Park, Do Jun Park, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Yeon Cho, Hong Kyu Lee
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J Korean Endocr Soc. 2002;17(1):95-103. Published online February 1, 2002
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Abstract
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Primary aldosteronism (PA) is believed to be a benign form of secondary hypertension due to the low incidence of hypertensive complications. Recently, several studies have shown that hypertensive complications were common in patients with PA. Therefore, we investigated hypertensive complications in 46 PA patients. METHEODS: Clinical and laboratory features of 46 46 patients were retrospectively analyzed. Hypertensive complications of this group were left ventricular hypertrophy, cerebrovascular accidents, hypertensive nephropathy and hypertensive retinopathy. RESULTS: Hypertensive complications were found in 30 (65.2%) of the 46 patients. The incidence of severe hypertension (higher than or equal to 110 mmHg in diastolic blood pressure) was 17.6%. Left ventricular hypertrophy was found in 26 (56.7%) of the 46 patients. Cerebrovascular accidents were found in 6 patients, and hypertensive nephropathy in 4 patients. The incidence of severe hypertensive retinopathy (higher than or equal to grade 3 in the Keith-Wagener Barker classification) was 17.6%. Of the 35 PA patients who underwent surgical treatment hypertension was found in 18 (51.4%). CONCLUSION: These results indicate that hypertensive complications are common in patients with PA, suggesting that early detection, treatment and close follow-up are necessary in PA.
- Clinical Course of Idiopathic Central Diabetes Insipidus in Adults.
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Hyeon Jeong Jeon, Soon Hee Park, Seong Hee Kwon, Sun Hwa Lee, Kyeong Soo Park
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J Korean Endocr Soc. 2001;16(2):190-198. Published online April 1, 2001
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Abstract
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Idiopathic Central Diabetes Insipidus in children or adolescents requires a frequent follow-up regimen using serial brain MRI and CSF examinations especially if an isolated pituitary stalk thickening or loss of a hyperintense signal in the posterior pituitary lobe is observed. Although a detailed description has not been made in adults who had Idiopathic Central Diabetes Insipidus, the clinical course of a Central Diabetes Insipidus in children or in adolescents can not be applied to adults because a follow-up study is so invasive and expensive. In this report, we evaluated the clinical course of Idiopathic Central Diabetes Insipidus in adults. METHODS: The diagnosis of Idiopathic Central Diabetes Insipidus was based on the presenting clinical symptoms, the water deprivation test, biochemical studies and a brain MRI. We measured the urine specific gravity, urine and plasma osmolarity, electrolytes, and daily urine amount and we also performed an anterior pituitary evaluation. Patients had contrast-enhanced MRI and biochemical studies every 4 to 12 months. RESULTS: The patients included 8 females and 4 males. Their ages ranged from 20 to 76 years and their mean age was 45+/-17 years. Tumor markers in the CSF were not detected any of the patients. An anterior pituitary evaluation showed that four patients had hyperprolactinemia, and five patients had impaired secretory responses of Growth Hormone to an insulin induced hypoglycemia. Nine of the 12 patients had thickening of the pituitary stalk, seven had lacked the hyperintense signal of a normal neurohypophysis. The abnormalities of MRI disappeared in 3 patients by the 4th, 27th and 36th month follow up periods, respectively. The follow up duration was between 8 months and 11 years 3 months and the mean follow up duration period was 50.6+/-45.5 months. Clinical symptoms were corrected by DDAVP administration. Other symptoms were absent. CONCLUSION: In our study, of Idiopathic Central Diabetes Insipidus in adults there were no observed germinomas or other disease that were observed. Therefore this disorder may have a benign course.
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