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dc.contributor.authorØksnes, Marianneeng
dc.contributor.authorBjörnsdottir, Sigridureng
dc.contributor.authorIsaksson, Magnuseng
dc.contributor.authorMethlie, Paaleng
dc.contributor.authorCarlsen, Sirieng
dc.contributor.authorNilsen, Roy Miodinieng
dc.contributor.authorBroman, Jan-Erikeng
dc.contributor.authorTriebner, Kaieng
dc.contributor.authorKämpe, Olleeng
dc.contributor.authorHulting, Anna-Lenaeng
dc.contributor.authorBensing, Sophieeng
dc.contributor.authorHusebye, Eystein Sverreeng
dc.contributor.authorLøvås, Kristianeng
dc.date.accessioned2015-03-18T12:53:32Z
dc.date.available2015-03-18T12:53:32Z
dc.date.issued2014eng
dc.identifier.issn0021-972Xeng
dc.identifier.urihttp://hdl.handle.net/1956/9578
dc.description.abstract<p>Context: Conventional glucocorticoid replacement therapy fails to mimic the physiological cortisol rhythm, which may have implications for morbidity and mortality in patients with Addison’s disease.</p><p>Objective: The objective of the study was to compare the effects of continuous sc hydrocortisone infusion (CSHI) with conventional oral hydrocortisone (OHC) replacement therapy.</p><p>Design, Patients, and Interventions: This was a prospective crossover, randomized, multicenter clinical trial comparing 3 months of treatment with thrice-daily OHC vs CSHI. From Norway and Sweden, 33 patients were enrolled from registries and clinics. All patients were assessed at baseline and after 8 and 12 weeks in each treatment arm.</p><p>Main Outcome Measures: The morning ACTH level was the primary outcome measure. Secondary outcome measures were effects on metabolism, health-related quality of life (HRQoL), sleep, and safety.</p><p>Results: CSHI yielded normalization of morning ACTH and cortisol levels, and 24-hour salivary cortisol curves resembled the normal circadian variation. Urinary concentrations of glucocorticoid metabolites displayed a normal pattern with CSHI but were clearly altered with OHC. Several HRQoLindices in the vitality domain improved over time with CSHI.Nobenefit was found for either treatments for any subjective (Pittsburgh Sleep Quality Index questionnaire) or objective (actigraphy) sleep parameters.</p><p>Conclusion: CSHI safely brought ACTH and cortisol toward normal circadian levels without adversely affecting glucocorticoid metabolism in the way that OHC did. Positive effects on HRQoL were noted with CSHI, indicating that physiological glucocorticoid replacement therapy may be beneficial and that CSHI might become a treatment option for patients poorly controlled on conventional therapy.</p>en_US
dc.language.isoengeng
dc.publisherEndocrine Societyeng
dc.relation.ispartof<a href="http://hdl.handle.net/1956/8326" target="blank">Glucocorticoid Treatment and Quality of Life in Addison’s disease</a>eng
dc.titleContinuous Subcutaneous Hydrocortisone Infusion versus Oral Hydrocortisone Replacement for Treatment of Addison’s Disease: A Randomized Clinical Trialeng
dc.typeJournal articleeng
dc.rights.holderCopyright 2014 by the Endocrine Society
dc.type.versionpublishedVersioneng
bora.peerreviewedPeer reviewedeng
bora.journalTitleJournal of Clinical Endocrinology and Metabolismeng
bibo.volume99eng
bibo.issue5eng
bibo.pageStart1665eng
bibo.pageEnd1674eng
bibo.eissn1945-7197eng
bibo.doihttp://dx.doi.org/10.1210/jc.2013-4253eng
bora.accessRightsinfo:eu-repo/semantics/openAccesseng
dc.identifier.cristinID1165600eng
dc.identifier.doi10.1210/jc.2013-4253
dcterms.isPartOfhttp://hdl.handle.net/1956/8326


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