What is glucocorticoid replacement therapy

Glucocorticoids are a type of hormone secreted by the zona fasciculata in the adrenal cortex, which has certain regulatory and metabolic effects. Many people also want to know about glucocorticoid replacement therapy, but most people do not understand what it means.

1. When the hypothalamic-pituitary-adrenal axis is dysfunctional, glucocorticoid replacement therapy is a commonly used method. Due to the differences between the pharmacokinetics of replacement hormones and the characteristics of hormone secretion themselves, as well as the different pathophysiology of each disease, the selection and administration of replacement hormones must be individualized.

2. The secretion of cortisol in normal people has the following characteristics: ① Rhythmic secretion cycle. Whether it is ACTH or cortisol, the secretion is highest between 6 and 9 am every day, then gradually decreases, reaching the lowest at midnight. ② Pulse secretion: The peak of pulse secretion is the highest and most intensive between 6 and 9 in the morning, then gradually becomes thinner and smaller, reaching the lowest point at midnight. ③ Any stress stimulation such as stressful surgery, trauma, infection, fever, acute myocardial infarction and cerebrovascular accident, even pain and mental tension can promote secretion.

3. Artificial hormone replacement lacks the above characteristics. For example, hydrocortisone is rapidly absorbed after oral administration, reaches a peak in about 30 minutes, and then rapidly declines, with a half-life of about 80 minutes. By the time the next dose is given, the blood concentration has dropped to very low levels. Therefore, in replacement therapy, the dose should be maximum in the morning and then gradually reduced, especially when short-acting preparations are administered in divided doses. When the patient is under stress, the replacement dose should be increased as appropriate.

4. Except for hydrocortisone, most of the glucocorticoids used in clinical treatment are artificially synthesized non-natural products. Understanding the characteristics of these hormones is very important for choosing alternative medicines.