Hi again Jenny,
Sorry...I don’t think the link I gave earlier worked because the URL was split into different lines. So, here is the info from the actual abstracts. I also pasted in a couple of other similar studies.
The first study below compares hydrocortisone given at different times.Like with the study proposed for your grandson, each schedule was given for 4-6 weeks, then bloodwork taken and the results compared. The other two studies compare dex, hydrocortisone, prednisone, and cortisone acetate, so they are probably a bit more similar to what your grandson’s doctors are proposing today.
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| 1: J Pediatr. 1985 Jan;106(1):137-42. | Related Articles,[unauthorised script deleted] language=JavaScript1.2>[unauthorised script deleted] language=JavaScript1.2> Links |
Effect of hydrocortisone dose schedule on adrenal steroid secretion in congenital adrenal hyperplasia.
Winterer J, Chrousos GP, Loriaux DL, Cutler GB Jr.
To explore the potential effect of dose schedule on the adrenal suppressive action of hydrocortisone in congenital adrenal hyperplasia, eight patients (six with 21-hydroxylase deficiency and two with 11-hydroxylase deficiency) were given five different dose schedules. Two of the schedules used single daily doses (morning or evening), two twice daily doses (two-thirds dose in the morning or evening), one and three equal doses at morning, noon, and night. Each dose schedule used the same total daily hydrocortisone dose (12.5 mg/m2/day), which is within the normal range of hydrocortisone production rate. Each schedule was given for 4 to 6 weeks. The different dose schedules caused the predicted alterations in the temporal pattern of adrenal steroid levels, with the greatest apparent suppression during the 2 to 4 hours after each dose. None of the schedules, however, caused significant differences in the mean 24-hour plasma concentration of 17-hydroxyprogesterone (21-hydroxylase deficiency) or 11-deoxycortisol (11-hydroxylase deficiency) or in the 24-hour urine pregnanetriol or 17-ketosteroid concentrations, either in the six patients undertreated at the dose of 12.5 mg/m2/day or in the two patients adequately treated. Nocturnal administration of all or a part of the daily dose did not improve adrenal suppression. These observations suggest that treatment of congenital adrenal hyperplasia with a once-a-day hydrocortisone dose schedule may be as effective as conventional multiple-dose schedules. Until this hypothesis has been tested by more extended clinical studies, however, we do not recommend a once-a-day schedule. Regardless of the dose schedule, the total daily hydrocortisone dose must be adjusted to achieve a normal rate of growth and bone age advancement.
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=934750&query_hl=4 | 1: Pediatrics. 1976 Jun;57(6):942-7. | Related Articles,[unauthorised script deleted] language=JavaScript1.2>[unauthorised script deleted] language=JavaScript1.2> Links |
Variable efficacy of glucocorticoids in congenital adrenal hyperplasia.
Hansen JW, Loriaux DL.
We have examined the suppression of urinary pregnanetriol and 17-ketosteroids during treatment with cortisol, cortisone, prednisone, and dexamethasone in eight patients with congenital adrenal hyperplasia. A large individual variation in response to each agent was observed. In some individuals, cortisone is less effective than its generally accepted potency would indicate. At equivalent glucocorticoid dosage, dexamethasone was twice as effective as the other steroids in suppressing urinary 17-ketosteroids and pregnanetriol. The potency of dexamethasone in suppressing adrenal function was 80 times that of cortisol, about twice its generally accepted potency as a glucocorticoid or anti-inflammatory agent.
| 1: Clin Endocrinol (Oxf). 1982 Dec;17(6):547-56. | Related Articles,[unauthorised script deleted] language=JavaScript1.2>[unauthorised script deleted] language=JavaScript1.2> Links |
A comparison of three glucocorticoid suppressive regimes in adults with congenital adrenal hyperplasia.
Horrocks PM, London DR.
We have compared three glucocorticoids, hydrocortisone (HC) (20 mg mane & 10 mg nocte), cortisone acetate (CA) (25 mg mane & 12.5 mg nocte), dexamethasone (DXM) (0.5 mg mane & 0.25 mg nocte), for their effect on the biochemical control of adult patients with congenital adrenal hyperplasia (CAH). Twenty-four-hour profiles of plasma concentrations of ACTH, 17-hydroxyprogesterone (170HP) and androstenedione (delta 4A), and 09.00 h dehydroepiandrosterone sulphate (DHAS) plasma concentrations were used to assess control. The patients were studied after 2 weeks on each glucocorticoid. The areas under the curves, the heights of the morning peaks of each hormone, the midnight concentrations, and the concentrations of hormones just before the evening dose were analysed. The results show that all the indices, except the midnight concentrations which were uniformly low, were significantly lower on DXM than on either HC or CA. There were no significant differences between HC and CA for any of the indices. The DHAS concentrations were low on all three glucocorticoids but again significantly lower on DXM. DXM (0.5 mg mane & 0.25 mg nocte) is therefore, in the short term, a better suppressor of the pituitary-adrenal axis in adults with CAH than either HC or CA, and in the dose used did not suppress ACTH to undetectable levels, nor the steroids to below levels found in normal subjects.