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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Comparison of glucocorticoid preparations used for treatment of adrenal insufficiency in children

Comparison of glucocorticoid preparations used for treatment of adrenal insufficiency in children
Glucocorticoids Glucocorticoid activity relative to hydrocortisone* Mineralocorticoid activity Plasma half-life (min)[1]
Short-acting
Hydrocortisone (cortisol) 1 Moderate 60 to 90
Intermediate-acting
Prednisone 5 Low 60
Prednisolone 5 Low 115 to 200
Long-acting
Dexamethasone 60 to 80 None 200
Mineralocorticoids Dose Mineralocorticoid activity Plasma half-life (min)[1]
Fludrocortisone 0.1 to 0.2 mgΔ High 200

* In this table, glucocorticoid activity refers to the relative effect as measured by growth suppression, which is thought to be the best measure of potency for patients with adrenal insufficiency[1-4]. The relative potency for antiinflammatory effects is somewhat lower.

¶ 20 mg of hydrocortisone and 25 mg of cortisone acetate each provide a mineralocorticoid effect that is approximately equivalent to 0.1 mg fludrocortisone[5].

Δ For patients with mineralocorticoid deficiency, the typical daily dose of fludrocortisone is 0.1 mg when given in conjunction with hydrocortisone (which has some mineralocorticoid activity). The dose is adjusted as needed to achieve normal plasma renin activity. It is not adjusted by weight, age, or body surface area, because the aldosterone secretion rate is nearly constant throughout the lifespan. Higher doses are occasionally needed in early infancy (eg, <4 months of age) due to physiologic resistance of the immature kidney to mineralocorticoid.
References:
  1. Finkielstain GP, Kim MS, Sinaii N, et al. Clinical characteristics of a cohort of 244 patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 2012; 97:4429.
  2. Nicolaides NC, Pavlaki AN, Alexandra M, Chrousos GP. Endotext: Glucocorticoid Therapy and Adrenal Suppression. 2018. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279156/ (Accessed on August 16, 2022).
  3. Hindmarsh PC. Management of the child with congenital adrenal hyperplasia. Best Pract Res Clin Endocrinol Metab 2009; 23:193.
  4. Rivkees SA, Crawford JD. Dexamethasone treatment of virilizing congenital adrenal hyperplasia: the ability to achieve normal growth. Pediatrics 2000; 106:767.
  5. Miller WL, Fluck CE, Breault DT, Feldman BJ. The adrenal cortex and its disorders. In: Sperling Pediatric Endocrinology, 5th ed, Sperling MA, Majzoub JA, Menon RK, Stratakis CA (Eds), Elsevier 2020.
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