monitoring levels of hydrocortisone

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I did a google search on monitoring levels of hydrocortisone and

found the following site. I would be interested in hearing what you

all think about this:

http://www.endocrine-abstracts.org/ea/0007/ea0007p224.htm

" Reproducibility of cortisol day curve in monitoring patients on long-

term Hydrocortisone Replacement Therapy

SKA Shakoor, M , SM Shalet & PJ Trainer

Department of Endocrinology, Christie Hospital, Manchester, UK.

The risks of over and under-replacement with glucocorticoid

replacement therapy are well-known. In an attempt to minimise these

risks cortisol day curves (CDC) are performed in many centres,

however there is a dearth of data on the reproducibility of this

assessment and the relationship between symptoms and serum cortisol

levels. To address these issues, we have performed 2 cortisol day

curves within 7 days in 20 patients (9 male, mean age 54 years, range

25-79, 6 primary and 14 secondary adrenal failure) on long- term

hydrocortisone (HC) replacement therapy; the total daily dose was

20/30 milligrams divided into twice or three times daily at standard

times. Serum cortisol was measured prior to the first dose of HC at

09.00, then at 30 minute intervals for 90 minutes, and hourly

intervals until 20.30. 24 hour urinary free cortisol (UFC) was

measured from 09.00 to 09.00, the following day. Simultaneous with

each blood sample patients completed visual analogue scales (VAS) for

tiredness, energy levels, and well-being. The median peak morning

serum cortisol was 640.5 nanomole per litre (range 411-921) and

occurred 90 minutes (range 30-120) after the dose. The median AUC and

UFC were 3346 (range 2166-5441) nanomole per litre /11.5 hours and

155 (range 28-538) nanomole per litre respectively. Comparison of

AUC, maximum and minimum serum cortisol, UFC for the 2 CDC were

within 10% of each other in 12, 9, 7, 4 patients and within 20% of

each other in 16, 15, 14, 6 patients respectively. There was no

significant correlation between serum cortisol and VAS for tiredness,

energy levels, and well-being. The reproducibility of the CDC is

acceptable but the relationship of serum cortisol to symptoms

requires further exploration. "

English