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Inicio Endocrinología y Nutrición Enfermedad de Addison. Tratamiento sustitutivo con glucocorticoides y su monitor...
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Vol. 50. Núm. 10.
Páginas 390-395 (octubre 2003)
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Vol. 50. Núm. 10.
Páginas 390-395 (octubre 2003)
Acceso a texto completo
Enfermedad de Addison. Tratamiento sustitutivo con glucocorticoides y su monitorización
Addison's disease. hydrocortisone replacement therapy and its monitoring
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16621
N. Alonsoa,
Autor para correspondencia
alucas@ns.hugtip.scs.es

Correspondencia: Dra. N. Alonso. Servicio de Endocrinología y Nutrición. Hospital Universitario Germans Trias i Pujol. Ctra. del Canyet, s/n. 08916 Badalona. Barcelona. España.
, M.L. Granadab, A. Lucasa, I. Salinasa, A. Sanmartía
a Servicio de Endocrinología y Nutrición. Hospital Universitario Germans Trias i Pujol. Badalona. Barcelona
b Servicio de Bioquímica. Hospital Universitario Germans Trias i Pujol. Badalona. Barcelona. España
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En esta revisión se repasan algunos aspectos del tratamiento sustitutivo con glucocorticoides en pacientes con enfermedad de Addison. Según opinión de algunos autores, la dosis tradicional de 30 mg/día de hidrocortisona, repartida en dos tomas, podría ser excesiva para la mayoría de los enfermos, por lo que debería administrarse en tres tomas. Así, se ha señalado que la sobreexposición prolongada a los glucocorticoides podría aumentar el riesgo de padecer osteoporosis. Por otra parte, aunque los pacientes con enfermedad de Addison tratados pueden llevar una vida normal, muchos de ellos aquejan fatiga, cansancio y disminución de la tolerancia al estrés, y en varios estudios se demuestra que presentan una alteración significativa de la calidad de vida relacionada con la salud (CVRS). Una explicación para este hallazgo podría ser el déficit de deshidroepiandrosterona (DHEA) que presentan y que también justificaría, al menos en parte, la peor CVRS observada en las mujeres. El tratamiento de este déficit de DHEA mejora algunos aspectos psicológicos. Tampoco resulta fácil establecer una pauta de tratamiento que imite el perfil fisiológico de secreción de cortisol, en los pacientes con enfermedad de Addison, si se consideran criterios bioquímicos. Por todo ello, como recomendación general proponemos iniciar el tratamiento sustitutivo de estos enfermos con 10-5-5 mg/día de hidrocortisona y aumentar esta dosis en los casos en que se detecte alteración de la CVRS.

Palabras clave:
Insuficiencia suprarrenal primaria
Enfermedad de Addison
Calidad de vida relacionada con la salud
Tratamiento sustitutivo con hidrocortisona
Perfil sérico de cortisol

Some aspects of glucocorticoid replacement therapy in Addison's disease patients are reviewed. According to some authors, the traditional regimen of hydrocortisone 30 mg/day, distributed into two doses, could be excessive in most patients and three administrations should be used. Chronic glucocorticoid overtreatment could increase the risk of osteoporosis. In addition, although treated patients with Addison's disease can lead a normal life, many suffer fatigue, tiredness, and reduced stress tolerance and several studies have demonstrated that they present significant alterations in health-related quality of life (HRQoL). An explanation for this finding could be dehydroepiandrosterone (DHEA) deficit, which would also explain, at least in part, the poorer HRQoL observed in women. Treatment of DHEA deficit improves some psychological features. In patients with Addison's disease it is not easy to establish a treatment that mimics the physiologic profile of cortisol secretion if biochemical approaches are used. Consequently, as a general recommendation, we propose beginning replacement therapy in these patients with 10mg-5mg-5mg/day of hydrocortisone and increasing this dose in patients who show alterations of CVRS.

Key words:
Primary adrenal insufficiency
Addison's disease
Health-related quality of life
Hydrocortisone replacement
Serum cortisol profile
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