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Variation in Absorption and Half-life of Hydrocortisone Influence Plasma Cortisol Concentrations.
[congenital adrenal hyperplasia]
Hydrocortisone
therapy
should
be
individualised
in
congenital
adrenal
hyperplasia
(
CAH
)
patients
to
avoid
over
and
under
replacement
.
We
have
assessed
how
differences
in
absorption
and
half
-life
of
cortisol
influence
glucocorticoid
exposure
.
48
patients
(
21
M
)
aged
between
6
.
1
and
20
.
3
years
with
CAH
due
to
CYP
21
A
2
deficiency
were
studied
.
Each
patient
underwent
a
24
h
plasma
cortisol
profile
with
the
morning
dose
used
to
calculate
absorption
parameters
along
with
an
intravenous
(
IV
)
hydrocortisone
(
15
mg
/
m
(
2
)
body
surface
area
)
bolus
assessment
of
half
-life
.
Parameters
derived
were
maximum
plasma
concentration
(
Cmax
)
,
time
of
maximum
plasma
concentration
(
tmax
)
,
time
to
attaining
plasma
cortisol
concentration
less
than
100
nmol
/
l
and
half
-life
of
cortisol
.
Mean
half
-life
was
76
.
5
±
5
.
2
(
range
40
-
225
.
3
)
min
,
Cmax
780
.
7
±
61
.
6
nmol
/
l
and
tmax
66
.
7
(
range
20
-
118
)
min
.
Time
taken
to
a
plasma
cortisol
concentration
less
than
100
nmol
/
l
was
289
(
range
140
-
540
)
min
.
Those
with
a
fast
half
-life
and
slow
tmax
took
longest
to
reach
a
plasma
cortisol
concentration
less
than
100
nmol
/
l
(
380
±
34
.
6
min
)
,
compared
to
those
with
a
slow
half
-life
and
fast
tmax
(
298
±
34
.
8
min
)
and
those
with
a
fast
half
-life
and
fast
tmax
(
249
.
5
±
14
.
4
min
)
(
One
way
ANOVA
F
=
4
.
52
;
P
=
0
.
009
)
CONCLUSIONS
:
Both
rate
of
absorption
and
half
-life
of
cortisol
in
the
circulation
play
important
roles
in
determining
overall
exposure
to
oral
glucocorticoid
.
Dose
regimens
need
to
incorporate
estimates
of
these
parameters
into
determining
the
optimum
dosing
schedule
for
individuals
.
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article
is
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.
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.