Would Cortisol Measurements Be a Better Gauge of Hydrocortisone Replacement Therapy? Congenital Adrenal Hyperplasia as an Exemplar

Figure 3

Hydrocortisone stacking in a prepubertal male aged 10 years with salt-wasting congenital adrenal hyperplasia on hydrocortisone dosing of 12 mg/m2/day and a 9-alpha fludrocortisone dose of 100 micrograms per day. A dose of hydrocortisone (7.5 mg) is given at time zero (time course depicted by the solid blue line). On a second occasion, a further lower dose (5.0 mg) (time course depicted by the dashed blue line) is given 180 minutes; later, the second dose stacks on top of the previous dose (see the circled point) giving a higher cortisol concentration than expected. Samples are drawn at 20-minute intervals Reproduced from Congenital Adrenal Hyperplasia: A Comprehensive Guide, Hindmarsh P and Geertsma K Elsevier, New York (2017).