Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new hydrocortisone research articles will be listed here shortly after becoming available to us.
Related Sponsors
Medical research on hydrocortisone
Low-dose hydrocortisone in the evening modulates symptom severity in restless legs syndrome.
Neurology. 2008 Apr 29; 70(18): 1620-2
Hornyak M, Rupp A, Riemann D, Feige B, Berger M, Voderholzer U
BACKGROUND: Circadian symptom manifestation in the evening and night is one of the main characteristics of restless legs syndrome (RLS). Although the inverse temporal course of corticosteroid rhythm and RLS symptom severity is obvious, this relationship has yet to be studied. We investigated the effect of late-evening application of exogenous cortisol (hydrocortisone) on sensory leg discomfort (SLD), one of the main complaints of patients with RLS. METHODS: Ten untreated patients with idiopathic RLS participated in the study. Change of SLD was rated on a visual analogue scale during the 60 minutes resting period of the so-called Suggested Immobilization Test. Patients received either hydrocortisone 40 mg or placebo (saline) IV in random order in a double-blind crossover design, with 1 week between the experiments. RESULTS: Severity of SLD was lower during hydrocortisone infusion than during placebo (p = 0.032). Though blind to the experimental condition, 5 of the 10 patients experienced improvement in symptoms during hydrocortisone administration, but no patient felt an amelioration during the placebo condition. CONCLUSIONS: Our data indicate a probable physiologic relationship between evening and early night hour restless legs syndrome symptom increase and low cortisol level.
World J Gastroenterol. 2008 Apr 28; 14(16): 2544-9
Willert RP, Lawrance IC
AIM: To determine if infliximab can prevent or delay surgery in refractory ulcerative colitis (UC). METHODS: UC patients who failed to have their disease controlled with conventional therapies and were to undergo colectomy if infliximab failed to induce a clinical improvement were reviewed. Patients were primarily treated with a single 5 mg/kg infliximab dose. The Colitis Activity Index (CAI) was used to determine response and remission. Data of 8 wk response and colectomy rates at 6 mo and 12 mo were collected. RESULTS: Fifteen patients were included, 7 with UC unresponsive or intolerant to IV hydrocortisone, and 8 with active disease despite oral steroids (all but one with therapeutic dosage and duration of immunomodulation). All the IV hydrocortisone-resistant/intolerant patients had been on azathioprine/6-MP < 8 wk. At 8 wk, infliximab induced a response in 86.7% (13/15) with 40% in remission (6/15). Within 6 mo of treatment 26.7% (4/15) had undergone colectomy and surgery was avoided in 46.6% (7/15) at 12 mo. The colectomy rate at 12 mo in those on immunomodulatory therapy < 8 wk at time of infliximab was 12.5% (1/8) compared with 100% (7/7) in patients who were on long-term maintenance immunomodulators (P < 0.02). CONCLUSION: Infliximab prevented colectomy due to active disease in immunomodulatory-naive, refractory UC patients comparable to the use of Cyclosporine. In patients, however, on effective dosage and duration of immunomodulation at time of infliximab therapy colectomy was not avoided.
Low-dose and high-dose adrenocorticotropin testing: indications and shortcomings.
Curr Opin Endocrinol Diabetes Obes. 2008 Jun; 15(3): 244-9
Dickstein G, Saiegh L
PURPOSE OF REVIEW: The 250 microg adrenocorticotropin test (high-dose test) is the most commonly used adrenal stimulation test, though the use of physiologic doses (1.0 microg or 0.5 microg/1.73 m) (low-dose test) has recently gained wider acceptance. These variants and the use of adrenocorticotropin test in the ICU, however, remain controversial. The validity of the low-dose test and the parameters for evaluation of high- and low-dose tests in different situations need reevaluation. RECENT FINDINGS: In the last few years, numerous studies have used the low-dose test as a single test following previous findings that it is more sensitive and accurate than the high-dose test. It is used mainly in secondary adrenal insufficiency and after treatment with therapeutic glucocorticosteroids to define hypothalamo-pituitary-adrenal suppression. Unless there is a very recent onset of disease, the results are interpreted by most researchers as diagnostic. The treatment of relative adrenal insufficiency, based on delta cortisol, has not yielded proof of correlation between this diagnosis and better prognosis with glucocorticoid treatment. SUMMARY: For interpretation of an adrenocorticotropin test, only peak - and not delta - cortisol should be used. The use of 240-300 mg of hydrocortisone daily in ICU patients, including septic shock, should be considered as pharmacologic, rather than as a replacement dose. Using the low-dose test for this purpose will lead to further misdiagnosis.
Hydrocortisone effects on cardiovascular variability in septic shock: a spectral analysis approach.
Crit Care Med. 2008 May; 36(5): 1481-6
Aboab J, Polito A, Orlikowski D, Sharshar T, Castel M, Annane D
RATIONALE: Septic shock may be associated with a loss in cardiovascular variability and adrenal dysfunction. OBJECTIVES: To investigate the relationship between cardiovascular autonomic modulation and adrenal function during sepsis. MEASUREMENT AND MAIN RESULTS: Seventy-five volunteers with septic shock and six healthy volunteers were prospectively included in the study. Cardiovascular variability was assessed by spectral analysis of heart rate and diastolic blood pressure signals, which included computation of normalized low (LF(nu)) and high frequency (HF(nu)) components. Cardiovascular variability was investigated in patients and healthy volunteers immediately before and 1 hr after a single bolus of 50 mg of hydrocortisone (study phase I); in patients according to adrenal function (study phase II); and in patients with septic shock and adrenal insufficiency, before and 72 hrs after a treatment with 50 mg every 6 hrs of hydrocortisone and 50 microg daily of fludrocortisone or their placebos (study phase III). As compared to healthy volunteers, patients had decreased LF(nu)-HR (.16 +/- .05 vs. .23 +/- .07 p = .01) and LF(nu)-DBP (.18 +/- .11 vs. .28 +/- .02 p = .01) and, after hydrocortisone, they had a greater increase in LF(nu)-DBP (p = .01). As compared to patients with normal adrenal function, those with adrenal failure had decreased LF(nu)-HR (.1 +/- .01 vs. .2 +/- .15 p = .01) and LF(nu)-DBP (.008 +/- .01 vs. .14 +/- .22 p = .0003). In patients with adrenal failure, as compared to placebos, hydrocortisone plus fludrocortisone increased significantly LF(nu)-DBP (p = .02) and low frequency/high volume ratio (p = .009). CONCLUSION: In septic shock, the loss in cardiovascular variability is more marked in patients with adrenal insufficiency and is partly restored by exogenous administration of corticosteroids.
Real-time analysis of gene regulation by glucocorticoid hormones.
J Endocrinol. 2008 May; 197(2): 205-11
McMaster A, Chambers T, Meng QJ, Grundy S, Loudon AS, Donn R, Ray DW
There is increasing evidence that temporal factors are important in allowing cells to gain additional information from external factors, such as hormones and cytokines. We sought to discover how cell responses to glucocorticoids develop over time, and how the response kinetics vary according to ligand structure and concentration, and hence have developed a continuous gene transcription measurement system, based on an interleukin-6 (IL-6) luciferase reporter gene. We measured the time to maximal response, maximal response and integrated response, and have compared these results with a conventional, end point glucocorticoid bioassay. We studied natural glucocorticoids (corticosterone and cortisol), synthetic glucocorticoids (dexamethasone) and glucocorticoid precursors with weak, or absent bioactivity. We found a close correlation between half maximal effective concentration (EC50) for maximal response, and for integrated response, but with consistently higher EC50 for the latter. There was no relation between the concentration of ligand and the time to maximal response. A comparison between conventional end point assays and real-time measurement showed similar effects for dexamethasone and hydrocortisone, with a less effective inhibition of IL-6 seen with corticosterone. We profiled the activity of precursor steroids, and found pregnenolone, progesterone, 21-hydroxyprogesterone and 17-hydroxyprogesterone all to be ineffective in the real-time assay, but in contrast, progesterone and 21-hydroxyprogesterone showed an IL-6 inhibitory activity in the end point assay. Taken together, our data show how ligand concentration can alter the amplitude of glucocorticoid response, and also that a comparison between real-time and end point assays reveals an unexpected diversity of the function of glucocorticoid precursor steroids, with implications for human disorders associated with their overproduction.
UVB photolysis of hydrocortisone 21-acetate.
J Pharm Biomed Anal. 2008 Mar 15;
Caffieri S, Dall'acqua S, Castagliuolo I, Brun P, Miolo G
Hydrocortisone 21-acetate (HCA) in methanol solution undergoes photodegradation under UVB light, as monitored by HPLC. Five main photoproducts have been isolated and characterized by means of NMR and mass spectroscopy. One of them derives from a Norrish I photoreaction which cleaves the C17-C20 bond of the steroid yielding the andro-derivative, a second product comes from a Yang-type photorearrangement which links C18 to C20 yielding a cyclobutane adduct. The former photoproduct, in turn, undergoes further photolysis giving rise to various photoproducts, of which three have been characterized. The first is a stereoisomer of the andro-derivative, the others arise from the opening of the five-membered ring. HCA also proved photounstable in the solid state and in a commercial formulation for topical use, thus confirming the requirements of the Pharmacopeias for light protection of this drug. Indeed, experiments on LPS-stimulated THP-1 cells demonstrated the loss of anti-inflammatory activity when HCA was UVB-photodegraded. The radical mechanism involved in HCA photolysis seems also responsible for the in vitro photohemolytic effect and lipid peroxidation induced by HCA in combination with UVB light.
Relapses of Inflammatory Bowel Disease During Pregnancy: In-Hospital Management and Birth Outcomes.
Am J Gastroenterol. 2008 Apr 16;
Reddy D, Murphy SJ, Kane SV, Present DH, Kornbluth AA
BACKGROUND: There are few studies that describe the medical treatment and colitis response rates among patients with a severe relapse of inflammatory bowel disease (IBD) during pregnancy, and few studies of the effect of such a relapse on birth outcomes in these patients. OBJECTIVES: To describe the treatment and response rates of severe colitis in pregnancy, and to assess the effects of a severe relapse of colitis during pregnancy on birth outcomes. METHODS: We performed a case control study of pregnant patients with IBD hospitalized for a disease relapse at two large treatment centers between 1989 and 2001. Details of management of disease relapse and maternal and fetal outcomes were recorded. RESULTS: Eighteen patients (11 ulcerative colitis, 6 Crohn's disease, 1 indeterminate colitis), mean age 28.6 yr (range 19-38) formed the study group; 41 age-matched pregnant IBD patients without disease relapse formed the control group. Study patients were hospitalized at a mean of 15.9-wk gestation (range 8-35) for a mean of 10.4 days (range 3-31). All 18 patients received IV hydrocortisone (mean dose 199 mg/day) and 7 patients (39%) either continued taking or were commenced on immunomodulators: IV cyclosporine (5 patients) and azathioprine/6-MP (3 patients). Fifteen patients (83%) had a clinical response to these medical treatments, 3 patients required colectomy. There were significant differences between study and control groups in gestation period (35.0 wk vs 38.7 wk, respectively, P= 0.0001) and birth weight (2,001 g vs 3,018 g, respectively, P < 0.0001). CONCLUSIONS: Treatment with IV hydrocortisone and IV cyclosporine appears effective at inducing remission of colitis but their use must continue to be confined to severely ill patients being treated at specialized centers. Severe relapses of colitis during pregnancy increase the risk of preterm birth and low birth weight.
Anesth Analg. 2008 May; 106(5): 1562-5, table of contents
Li Y, Zhu S, Yan M
BACKGROUND: We designed this study to investigate the effect of 0.375% ropivacaine on stress hormone responses and anesthetic requirements in combined epidural/general anesthesia for nephrectomy. METHODS: Thirty-two adults, ASA physical status I-II, undergoing nephrectomy lasting about 2 h for renal carcinoma were randomly assigned to one of two groups: epidural (saline)/general anesthesia (group C) and epidural (0.375% ropivacaine)/general (group R) anesthesia. Induction of anesthesia was performed with target-controlled infusion sufentanil and propofol titrated to achieve bispectral index score (define) between 40 and 50. Endotracheal intubation was facilitated by the target-controlled infusion administration of vecuronium. After intubation, anesthesia was maintained with propofol infusion titrated to maintain bispectral index between 40 and 50. The target concentration of sufentanil was titrated according to arterial blood pressure and heart rate. Plasma samples were taken immediately before, 2 min after tracheal intubation, immediately after incision, immediately after the initiation of celiac exploration, 1 h after operation, and immediately after tracheal extubation for measurements of epinephrine, glucose, and cortisol in both groups. RESULTS: The relative changes of plasma concentrations of glucoses and cortisol were higher at 1 h after operation and immediately after extubation in group C when compared with group R. The plasma concentrations of epinephrine in both groups were similar. The requirements of propofol for induction and maintenance of anesthesia were not statistically different in the groups, but the requirement of sufentanil during maintenance was significant reduced in group R (P < 0.05). CONCLUSIONS: Epidural ropivacaine 0.375% suppressed stress hormone responses and sufentanil requirements perioperatively during maintenance of anesthesia for nephrectomy.
Gynecol Obstet Fertil. 2008 Apr; 36(4): 413-416
Legendre G, Vauthier-Brouzes D, Cornet A, Al Hawari M, Renard-Penna R, Piette JC, Dommergues M
Adrenal necrosis, a rare life threatening complication of antiphospholipid syndrome, is difficult to diagnose during pregnancy. We report the case of a 33-year-old woman with bilateral adrenal necrosis which started during the third trimester of her second pregnancy. Antiphospholipid syndrome had been diagnosed few years ago, after a thrombotic event. The pregnancy was uneventful until 36 weeks plus five days, when the patient was admitted for bilateral back ache, initially considered as uterine contractions. Labour was induced because pain persisted and was associated with major thrombocytopenia. A healthy infant was delivered vaginally on the second day, adrenal failure was diagnosed based on intense asthenia, persistent severe lumbar pain, low blood sodium and cortisol. Bilateral adrenal oedema was documented by CT scan and MRI. Symptoms resolved following administration of hydrocortisone and fludrocortisone. This case illustrates the difficulty to diagnose adrenal necrosis in the third trimester of pregnancy.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Jan; 28(1): 64-7
Du J, Ling CQ, Chen YA
OBJECTIVE: To evaluate the effect of Herba Epimedii Brevicornus (HEB) and prepared Radix Rehmannia (RR), the representative Chinese herbs for warming yang and nourishing yin on glucocorticoid receptor (GR) in GR down-regulated rats. METHODS: The GR down-regulated model was established by subcutaneous injection of hydrocortisone. Seventy-two SD male rats were randomly divided into four groups: the normal group; the model group (MG) ; the HEB group, and the RR group. And every group was subdivided to 3 batches depending on the time points (the 3rd, 7th and 14th day after modeling) of observation, with 6 rats in each batch. Changes in blood level of corticosterone (GS), as well as protein expression and binding power of GR in splenic lymphocytes at corresponding time points of the batches were determined by RIA and flow cytometry. RESULTS: No significantly difference was found in blood GS levels of the model group at all the time points, as compared with that of the normal group (P > 0.05), while that in the RR group was significantly lowered at the 14th day, and showed significant difference from that in the model group (P < 0.05). The protein expression and binding power in the model rats were lower than those in normal ones (all P < 0.01), but they were significantly higher on the 7th and 14th day in the RR group (P < 0.01), and on the 14th day in the HEB group higher than those in the model group, respectively (all P < 0.01). CONCLUSION: Both HEB and RR, in dosage-form of water decoction, could up-regulate the protein expression and binding power of GR in GR down-regulated model rats, but different in acting time.