Which medications in the drug class Glucocorticoids are used in the treatment of Pediatric Adrenal Insufficiency (Addison Disease)?

Updated: Dec 07, 2018
  • Author: Kimberly Tafuri, DO; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

Glucocorticoids

Glucocorticoid agents give patients with adrenal insufficiency (Addison disease) the equivalent of the body's missing cortisol produced by the adrenal cortex under normal conditions and under stress. Dexamethasone and betamethasone cross the placenta to an appreciable degree; therefore, both agents should not be used in pregnant women unless they are specifically indicated (ie, to aid maturation of the fetal lung or to suppress fetal adrenal function).

Hydrocortisone (Cortef, Solu-Cortef, A-Hydrocort)

Hydrocortisone is the glucocorticoid drug of choice (DOC) because of its mineralocorticoid activity and glucocorticoid effects and its equivalency to the adrenal product (ie, cortisol). This agent has a short half-life; therefore, hydrocortisone does not inhibit growth in children to same degree as more potent, longer-acting synthetic glucocorticoid agents (eg, prednisone, methylprednisolone, dexamethasone). Because of short action, hydrocortisone must be administered orally (PO) twice or thrice daily (bid/tid). When administered intravenously, hydrocortisone is usually given every 6 hours.

In healthy person, mean cortisol secretion is about 5-10 mg/m2/d. The aim of replacement therapy is to supply only as much as needed. The target level is best judged subjectively on basis of patient's own sense of well-being.

Dose requirements are greater PO than parenterally because some hydrocortisone is inactivated as it passes through liver. Equivalent low doses can be derived for prednisone, methylprednisolone, and dexamethasone (which have a minimum of about 4, 5, and 40-50 times the potency of hydrocortisone, respectively).

Dexamethasone (Baycadron)

Dexamethasone provides glucocorticoid activity. At pharmacologic doses, this agent decreases inflammation by suppressing migration of polymorphonuclear leukocytes and by reducing capillary permeability. Dexamethasone and prednisone may be used for allergic and inflammatory conditions.

Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)

Methylprednisolone also provides glucocorticoid activity. At pharmacologic doses, this agent decreases inflammation by suppressing migration of polymorphonuclear leukocytes and by reversing increased capillary permeability.

Methylprednisolone is available in a liquid formulation, unlike hydrocortisone.

Prednisone

Prednisone provides glucocorticoid activity. At pharmacologic doses, this agent decreases inflammation by suppressing migration of polymorphonuclear leukocytes and by reversing increased capillary permeability. Like methylprednisolone, prednisone is available in a liquid formulation.


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