P. Hindmarsh, Kathy Geertsma
2017
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Abstract
Glucocorticoids were developed to treat inflammatory conditions such as arthritis. Synthesis of cortisone acetate and then hydrocortisone, the synthetic form of cortisol, meant that adrenal replacement therapy was possible. This was life saving. Initially high doses of cortisone acetate were used, then hydrocortisone was introduced and doses gradually reduced to 10–12 mg/m 2 /day. Over time therapy moved from twice to three times daily and now 4 times daily. Side effects relate to dose, so suppression of height occurs when doses exceed 30 mg/m 2 /day. Prednisolone and dexamethasone were derived as more potent anti-inflammatory glucocorticoids . They also suppress growth and are not recommended as replacement therapies in adrenal insufficiency. Dose replacement should be fine tuned using 24 hour profiles measuring cortisol and 17-hydroxyprogesterone.