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09-11-2008, 09:00 AM
Related Articles (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Display&dopt=PubMed_PubMed&from_uid=18782876) CONTROL OF CHILDHOOD CONGENITAL ADRENAL HYPERPLASIA AND SLEEP ACTIVITY AND QUALITY WITH MORNING OR EVENING GLUCOCORTICOID THERAPY.
J Clin Endocrinol Metab. 2008 Sep 9;
Authors: German A, Suraiya S, Tenenbaum-Rakover Y, Koren I, Pillar G, Hochberg Z
Context: Traditionally, hydrocortisone replacement therapy in congenital adrenal hyperplasia (CAH) is given by three daily doses, albeit not necessarily of equal quantity. While a higher dose in the morning better imitates the physiological diurnal variation, a late-night higher dose was suggested to better suppress early morning hypothalamic pituitary adrenal (HPA) axis peak activity. Yet, increased night cortisol has been claimed to be associated with sleep disturbances and insomnia. Objective: To evaluate evening versus morning high hydrocortisone dose with respect to disease control, sleep pattern, and day time activity in children with CAH. Design: An open-label, cross-over, randomized trial of fifteen children with classical CAH. Patients were randomized to receive 50% of the daily hydrocortisone in the morning or evening for two weeks; the other two doses included 25% of the daily dose each. Outcome measures: Disease control was assessed by 8 a.m. 17-hydroxyprogesterone (17OHP), testosterone, androstendione and DHEAS on the last day of each treatment schedule. Sleep and daytime activity were assessed by a 7-day actigraph. Results: Basal morning androstenedione, 17OHP, DHEAS and testosterone levels during the high morning and the high evening hydrocortisone treatment schedules were comparable. There were no significant differences in sleep or daytime activity. Conclusions: With respect to disease control, sleep quality and day time activity were not affected by treatment schedules. We recommend the high morning dose schedule in replacement therapy of children with CAH.
PMID: 18782876 [PubMed - as supplied by publisher]
More... (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=18782876&dopt=Abstract)
J Clin Endocrinol Metab. 2008 Sep 9;
Authors: German A, Suraiya S, Tenenbaum-Rakover Y, Koren I, Pillar G, Hochberg Z
Context: Traditionally, hydrocortisone replacement therapy in congenital adrenal hyperplasia (CAH) is given by three daily doses, albeit not necessarily of equal quantity. While a higher dose in the morning better imitates the physiological diurnal variation, a late-night higher dose was suggested to better suppress early morning hypothalamic pituitary adrenal (HPA) axis peak activity. Yet, increased night cortisol has been claimed to be associated with sleep disturbances and insomnia. Objective: To evaluate evening versus morning high hydrocortisone dose with respect to disease control, sleep pattern, and day time activity in children with CAH. Design: An open-label, cross-over, randomized trial of fifteen children with classical CAH. Patients were randomized to receive 50% of the daily hydrocortisone in the morning or evening for two weeks; the other two doses included 25% of the daily dose each. Outcome measures: Disease control was assessed by 8 a.m. 17-hydroxyprogesterone (17OHP), testosterone, androstendione and DHEAS on the last day of each treatment schedule. Sleep and daytime activity were assessed by a 7-day actigraph. Results: Basal morning androstenedione, 17OHP, DHEAS and testosterone levels during the high morning and the high evening hydrocortisone treatment schedules were comparable. There were no significant differences in sleep or daytime activity. Conclusions: With respect to disease control, sleep quality and day time activity were not affected by treatment schedules. We recommend the high morning dose schedule in replacement therapy of children with CAH.
PMID: 18782876 [PubMed - as supplied by publisher]
More... (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?tmpl=NoSidebarfile&db=PubMed&cmd=Retrieve&list_uids=18782876&dopt=Abstract)