{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T18:34:06Z","timestamp":1725042846871},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,6,6]],"date-time":"2012-06-06T00:00:00Z","timestamp":1338940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2012,7]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p><jats:bold>Background\u2002<\/jats:bold> Hypopituitarism is associated with increased cardiovascular mortality, and it has been suggested that unphysiological glucocorticoid replacement regimens might contribute to this risk. Traditional glucocorticoid replacement regimens have often led to excessive serum cortisol levels. The hypercortisolaemia of Cushing\u2019s syndrome is associated with an increased risk of thromboembolism.<\/jats:p><jats:p><jats:bold>Objective\u2002<\/jats:bold> To examine whether short\u2010term higher\u2010dose hydrocortisone replacement regimens adversely affect the fibrinolytic system.<\/jats:p><jats:p><jats:bold>Design\u2002<\/jats:bold> Crossover study comparing tailored low\u2010dose (LD) glucocorticoid regimen (mean, 17\u00b75\u2003mg hydrocortisone daily), with a traditional high\u2010dose (HD, 30\u2010mg hydrocortisone daily) regimen for 2\u2003weeks.<\/jats:p><jats:p><jats:bold>Patients\u2002<\/jats:bold> Ten patients with hypopituitarism and ACTH deficiency \u2013 median (range) age, 59 (41\u201375) years \u2013 and 10 age\u2010 and sex\u2010matched controls. Nine patients had growth hormone deficiency (five replaced), nine patients had TSH deficiency (nine replaced), eight had gonadotrophin deficiency (five replaced). During the study, other pituitary hormone replacement therapy remained unchanged. Patients with acromegaly and Cushing\u2019s syndrome were excluded.<\/jats:p><jats:p><jats:bold>Measurements\u2002<\/jats:bold> Hourly serum cortisol for 11\u2003h, plasminogen activator inhibitor\u20101 (PAI\u20101), tissue plasminogen activator (tPA) and fibrinogen levels after 2\u2003weeks of treatment with both LD and HD regimens.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> No overall significant differences were found between the three groups using the Kruskal\u2013Wallis test: PAI\u20101: [median (range)] HD, 25 (5\u201353) ng\/ml; LD, 21 (4\u201356) ng\/ml; controls, 27 (8\u201351); <jats:italic>P<\/jats:italic>\u2003=\u20030\u00b73; tPA: HD, 10 (5\u201315) ng\/ml; LD, 10 (4\u201313) ng\/ml; controls 10 (3\u201313); <jats:italic>P<\/jats:italic>\u2003=\u20030\u00b746; and fibrinogen: HD, 2\u00b75 (1\u00b78\u20133\u00b75) g\/l; LD, 3\u00b70 (2\u00b73\u20134\u00b74) g\/l; controls, 2\u00b76 (1\u00b76\u20133\u00b72): <jats:italic>P<\/jats:italic>\u2003=\u20030\u00b797 In addition, no significant differences between HD and LD using Wilcoxon\u2019s paired test; PAI\u20101 (<jats:italic>P<\/jats:italic>\u2003=\u20030\u00b791), tPAag (<jats:italic>P<\/jats:italic>\u2003=\u20030\u00b747) and fibrinogen (<jats:italic>P<\/jats:italic>\u2003=\u20030\u00b709).<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> An increased dose of hydrocortisone for 2\u2003weeks creates excessive glucocorticoid exposure, but does not significantly affect fibrinolytic\u2010coagulation parameters.<\/jats:p>","DOI":"10.1111\/j.1365-2265.2011.04314.x","type":"journal-article","created":{"date-parts":[[2011,12,12]],"date-time":"2011-12-12T06:40:45Z","timestamp":1323672045000},"page":"94-98","source":"Crossref","is-referenced-by-count":5,"title":["Glucocorticoid replacement therapy and fibrinolysis in patients with hypopituitarism"],"prefix":"10.1111","volume":"77","author":[{"given":"Steven 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