TY - JOUR
T1 - The effects of two different doses of hydrocortisone on cognition in patients with secondary adrenal insufficiency - Results from a randomized controlled trial
AU - Buning, Jorien Werumeus
AU - Brummelman, Pauline
AU - Koerts, Janneke
AU - Dullaart, Robin P. F.
AU - van den Berg, Gerrit
AU - van der Klauw, Melanie M.
AU - Tucha, Oliver
AU - Wolffenbuttel, Bruce H. R.
AU - van Beek, Andre P.
N1 - Copyright © 2015 Elsevier Ltd. All rights reserved.
PY - 2015/5
Y1 - 2015/5
N2 - Context: A wide variety in hydrocortisone (HC) substitution dose-regimens are considered physiological for patients with secondary adrenal insufficiency (SAD. However, it is likely that cognition is negatively influenced by higher cortisol exposure to the brain.Objective: To examine the effects of a high physiological HC dose in comparison to a low physiological HC dose on cognition.Design and setting: This study was a randomized double blind cross-over study at the University Medical Center Groningen. This study is registered with ClinicalTrials.gov, number NCT01546922.Patients: Forty-seven patients (29 males, 18 females; mean [SD] age, 51 [14] years, range 19-73) with SAI participated.Intervention(s): Patients randomly received first a low dose of HC (0.2-0.3 mg/kg body weight/day) during 10 weeks followed by a high dose (0.4-0.6 mg/kg body weight/day) for another 10 weeks, or vice versa. HC substitution was given in three divided doses with the highest dose in the morning.Main outcome measure(s): Cognitive performance (memory, attention, executive functioning and social cognition) of patients was measured at baseline and after each treatment period using a battery of 12 standardized cognitive tests.Results: The higher dose of HC resulted in significantly higher systemic cortisol exposure for example measured at 1 h after first dose ingestion (mean [SD], low dose: 653 [281] nmol/L; high dose: 930 [148] nmol/L; PConclusions: No negative influence on memory, attention, executive functioning and social cognition was observed after 10 weeks of treatment with a higher physiological dose of HC in patients with SAI when compared to a lower dose. (C) 2015 Elsevier Ltd. All rights reserved.
AB - Context: A wide variety in hydrocortisone (HC) substitution dose-regimens are considered physiological for patients with secondary adrenal insufficiency (SAD. However, it is likely that cognition is negatively influenced by higher cortisol exposure to the brain.Objective: To examine the effects of a high physiological HC dose in comparison to a low physiological HC dose on cognition.Design and setting: This study was a randomized double blind cross-over study at the University Medical Center Groningen. This study is registered with ClinicalTrials.gov, number NCT01546922.Patients: Forty-seven patients (29 males, 18 females; mean [SD] age, 51 [14] years, range 19-73) with SAI participated.Intervention(s): Patients randomly received first a low dose of HC (0.2-0.3 mg/kg body weight/day) during 10 weeks followed by a high dose (0.4-0.6 mg/kg body weight/day) for another 10 weeks, or vice versa. HC substitution was given in three divided doses with the highest dose in the morning.Main outcome measure(s): Cognitive performance (memory, attention, executive functioning and social cognition) of patients was measured at baseline and after each treatment period using a battery of 12 standardized cognitive tests.Results: The higher dose of HC resulted in significantly higher systemic cortisol exposure for example measured at 1 h after first dose ingestion (mean [SD], low dose: 653 [281] nmol/L; high dose: 930 [148] nmol/L; PConclusions: No negative influence on memory, attention, executive functioning and social cognition was observed after 10 weeks of treatment with a higher physiological dose of HC in patients with SAI when compared to a lower dose. (C) 2015 Elsevier Ltd. All rights reserved.
KW - Cognition
KW - Hydrocortisone
KW - Secondary adrenal insufficiency
KW - QUALITY-OF-LIFE
KW - GLUCOCORTICOID REPLACEMENT
KW - DECLARATIVE MEMORY
KW - CORTISOL-LEVELS
KW - HYPOPITUITARY PATIENTS
KW - SOCIAL COGNITION
KW - SERUM CORTISOL
KW - DOUBLE-BLIND
KW - STRESS
KW - CORTICOSTEROIDS
U2 - 10.1016/j.psyneuen.2015.02.001
DO - 10.1016/j.psyneuen.2015.02.001
M3 - Article
C2 - 25705800
SN - 0306-4530
VL - 55
SP - 36
EP - 47
JO - Psychoneuroendocrinology
JF - Psychoneuroendocrinology
ER -