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

Figure 4

Plasma cortisol (filled area) and 17 hydroxyprogesterone (purple line with triangles) concentrations obtained after three oral doses of hydrocortisone given at 08 : 00 (7.5 mg), 15 : 00 (5.0 mg), and 22 : 00 h (5.0 mg) in a single 12-year-old pubertal female with salt-wasting congenital adrenal hyperplasia on hydrocortisone dosing of 12 mg/m2/day and 9-alpha fludrocortisone dose of 100 micrograms per day. Average circadian plasma cortisol concentrations from the 28 short normal children are shown as the blue dashed line. Note the periods of time without cortisol and the rise in 17 hydroxyprogesterone concentrations from 04 : 00 h. Blood spot 17 hydroxyprogesterone concentrations are shown in boxes (single sample in orange and several samples in green) for comparison. Blood sampling was at 1-hour intervals. Reproduced from Congenital Adrenal Hyperplasia: A Comprehensive Guide, Hindmarsh P and Geertsma K Elsevier, New York (2017).