{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:14:19Z","timestamp":1783440859075,"version":"3.54.6"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T00:00:00Z","timestamp":1674086400000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001659","name":"German Research Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Poorly controlled salt-wasting (SW) congenital adrenal hyperplasia (CAH) patients often require high 9\u03b1-fluorocortisol doses as they show high levels of 17-hydroxyprogesterone (17OHP), which is a mineralocorticoid (MC)-receptor antagonist.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>We investigated the renin\u2013angiotensin\u2013aldosterone system in patients with SW-CAH receiving twice daily modified-release hydrocortisone (MR-HC, Efmody) compared with standard glucocorticoid (GC) therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data were analyzed from the 6-month, phase 3 study of MR-HC (n = 42) versus standard GC therapy (n = 41). MC replacement therapy remained unchanged throughout the study. Blood pressure, serum potassium, serum sodium, plasma renin activity (PRA), and serum 17OHP and androstenedione concentrations were analyzed at baseline, 4, 12, and 24 weeks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The median serum 17OHP in the morning was significantly lower on MR-HC compared with standard GC at 24 weeks (2.5\u2005nmol\u2005L\u20131 (IQR 8.3) versus 10.5\u2005nmol\u2005L\u20131 (IQR 55.2), P = .001). PRA decreased significantly from baseline to 24 weeks in patients on MR-HC (0.83\u2005ng\u2005L\u20131\u2005s\u20131 (IQR 1.0) to 0.48\u2005ng\u2005L\u20131\u2005s\u20131 (IQR 0.61), P = .012) but not in patients on standard GC (0.53\u2005ng\u2005L\u20131\u2005s\u20131 (IQR 0.66) to 0.52\u2005ng\u2005L\u20131\u2005s\u20131 (IQR 0.78), P = .613). Serum sodium concentrations increased from baseline to 24 weeks in patients on MR-HC (138.8 \u00b1 1.9\u2005mmol\u2005L\u20131 to 139.3 \u00b1 1.8\u2005mmol\u2005L\u20131, P = .047), but remained unchanged on standard GC (139.8 \u00b1 1.6\u2005mmol\u2005L\u20131 to 139.3 \u00b1 1.9\u2005mmol\u2005L\u20131, P = .135). No significant changes were seen in systolic and diastolic blood pressure and serum potassium levels.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>6 months of MR-HC therapy decreased PRA and increased sodium levels indicating a greater agonist action of the 9\u03b1-fluorocortisol dose, which may be due to the decreased levels of the MC-receptor antagonist 17OHP.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejendo\/lvac006","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T06:25:49Z","timestamp":1674109549000},"page":"109-117","source":"Crossref","is-referenced-by-count":15,"title":["Modified-release hydrocortisone is associated with lower plasma renin activity in patients with salt-wasting congenital adrenal hyperplasia"],"prefix":"10.1093","volume":"188","author":[{"given":"Lea","family":"Tschaidse","sequence":"first","affiliation":[{"name":"Medizinische Klinik und Poliklinik IV, Klinikum der Universit\u00e4t M\u00fcnchen , Munich , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7469-6069","authenticated-orcid":false,"given":"Nicole","family":"Reisch","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik IV, Klinikum der Universit\u00e4t M\u00fcnchen , Munich , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5106-9719","authenticated-orcid":false,"given":"Wiebke","family":"Arlt","sequence":"additional","affiliation":[{"name":"Institute of Metabolism and Systems Research (IMSR), University of Birmingham , Birmingham , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aude","family":"Brac de la Perriere","sequence":"additional","affiliation":[{"name":"Hospices Civils de Lyon, Fe\u0301de\u0301ration d\u2019Endocrinologie, Groupement hospitalier Est , Bron Cedex , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelica","family":"Linden Hirschberg","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s and Children\u2019s Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0534-4350","authenticated-orcid":false,"given":"Anders","family":"Juul","sequence":"additional","affiliation":[{"name":"Department of Growth and Reproduction, Copenhagen University Hospital \u2013 Rigshospitalet , Copenhagen , Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0637-4559","authenticated-orcid":false,"given":"Ashwini","family":"Mallappa","sequence":"additional","affiliation":[{"name":"AstraZeneca , Gaithersburg, Maryland , United States"},{"name":"National Institutes of Health Clinical Center , Bethesda, Maryland , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah P","family":"Merke","sequence":"additional","affiliation":[{"name":"National Institutes of Health Clinical Center , Bethesda, Maryland , United States"},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development , Bethesda, Maryland , United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D C","family":"Newell-Price","sequence":"additional","affiliation":[{"name":"University of Sheffield , Sheffield , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin G","family":"Perry","sequence":"additional","affiliation":[{"name":"Queen Elizabeth University Hospital , Glasgow , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4821-0336","authenticated-orcid":false,"given":"Alessandro","family":"Prete","sequence":"additional","affiliation":[{"name":"Institute of Metabolism and Systems Research (IMSR), University of Birmingham , Birmingham , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D Aled","family":"Rees","sequence":"additional","affiliation":[{"name":"Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University , Cardiff , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nike M M L","family":"Stikkelbroeck","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center , Nijmegen , Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8462-7753","authenticated-orcid":false,"given":"Philippe A","family":"Touraine","sequence":"additional","affiliation":[{"name":"University Hospitals Piti\u00e9 Salp\u00eatri\u00e8re - Charles Foix, Center for Rare Endocrine and Gynecological Disorders , Paris , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Coope","sequence":"additional","affiliation":[{"name":"Diurnal Ltd , Cardiff , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Porter","sequence":"additional","affiliation":[{"name":"Diurnal Ltd , Cardiff , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard John M","family":"Ross","sequence":"additional","affiliation":[{"name":"University of Sheffield , Sheffield , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4028-1671","authenticated-orcid":false,"given":"Marcus","family":"Quinkler","sequence":"additional","affiliation":[{"name":"Endocrinology in Charlottenburg , Berlin , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,1,19]]},"reference":[{"issue":"11","key":"2023072118275818600_lvac006-B1","doi-asserted-by":"crossref","first-page":"4043","DOI":"10.1210\/jc.2018-01865","article-title":"Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society Clinical Practice Guideline","volume":"103","author":"Speiser","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2023072118275818600_lvac006-B2","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1210\/jc.2014-3809","article-title":"A phase 2 study of Chronocort, a modified-release formulation of 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