Rectal hydrocortisone during stress in patients with adrenal
insufficiency |
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Authors: | M De Vroede R Beukering M Spit M Jansen |
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Institution: | Department of Pediatrics, Wilhelmina Children''s Hospital, Utrecht University, Netherlands. |
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Abstract: | OBJECTIVE—Patients with glucocorticoid deficiency
need lifelong glucocorticoid replacement treatment. During acute
stressful events, steroid dosage must be increased several times, which
is often problematical in children. This study investigated the
reliability of rectal hydrocortisone administration as an
alternative to the intramuscular route. STUDY DESIGN—Serum cortisol was assessed during
stress in normal children to determine the concentration that should be
achieved after rectal hydrocortisone. Subsequently, serum cortisol
concentrations were measured three hours after administering a
suppository containing hydrocortisone
100 mg/m2 to 57 patients with adrenocortical
insufficiency. In eight patients, the time dependency of the cortisol
rise after rectal administration was established. RESULTS—In 51 previously healthy children
admitted to hospital with an acute stressful condition, the mean serum
cortisol concentration was 1092 nmol/l. Rectal hydrocortisone in
patients with adrenocortical insufficiency resulted in a mean serum
cortisol concentration of 1212 nmol/l three hours after insertion of
the suppository containing hydrocortisone. In 14 of 57 children, serum
cortisol was < 1000 nmol/l and in eight children it was below
600 nmol/l. One hour after administration, the mean cortisol
concentration had reached 1000 nmol/l. This was sustained for more
than four hours. CONCLUSION—Rectal hydrocortisone
is a safe alternative to parenteral administration in
the self management of Addisonian prone conditions. However, because
eight of 57 children did not achieve concentrations > 600 nmol/l,
its use is recommended only after previously documenting an adequate
serum cortisol concentration three hours after receiving a test dose.
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