Proof of concept for a superior therapeutic index of corticosterone compared with hydrocortisone in patients with congenital adrenal hyperplasia
Authors' conclusion
Corticosterone acutely controls biochemical markers of androgen excess similarly to hydrocortisone but without inducing markers of glucocorticoid "toxicity" in CAH. These data demonstrate proof of concept that corticosterone may be a safer glucocorticoid replacement than current medications, although further research is required to assess the longer-term effects of corticosterone replacement.
Study context
- Population
- Patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (8 female, 5 male)completed crossover
- Participants
- 13 patients
- Comparison
- 5 h IV corticosterone vs hydrocortisone vs placebo
Methodological detailsplacebo-controlled, crossover, proof of concept
- Placebo-controlled
- Crossover
- Proof of concept
Primary result
As reported in the abstract
Adrenal androgen markers and metabolic effects · during 5 h infusion
- Corticosterone and hydrocortisone similarly reduced ACTH, 17α-hydroxyprogesterone, androstenedione and testosterone (females only) vs placebo
- Circulating corticosterone concentrations ∼2.5-fold higher than hydrocortisone
- By T + 300 min hydrocortisone but not corticosterone increased glucose and insulin and reduced 6-6-[2H]2-glucose clearance vs placebo
Further findings
Adipose PER1 mRNA · end of infusion
- Hydrocortisone increased adipose PER1 mRNA to a greater extent than corticosterone
Original publication
Proof of concept for a superior therapeutic index of corticosterone compared with hydrocortisone in patients with congenital adrenal hyperplasia. Eur J Endocrinol. Published 15 November 2024. doi:10.
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