Usage of continuous glucose monitoring (CGM) for detecting an unrecognized hypoglycemia and management of glucocorticoid replacement therapy in adult patients with central hypoadrenalism

被引：14

作者：

Watanabe, Takuya ^{[1
]}

Ozawa, Atsushi ^{[1
]}

Ishii, Sumiyasu ^{[1
]}

Tomaru, Takuya ^{[1
]}

Shibusawa, Nobuyuki ^{[1
]}

Saito, Tsugumichi ^{[1
]}

Yamada, Eijiro ^{[1
]}

Horiguchi, Kazuhiko ^{[1
]}

Nakajima, Yasuyo ^{[1
]}

Matsumoto, Shunichi ^{[1
]}

Yoshino, Satoshi ^{[1
]}

Katano-Toki, Akiko ^{[1
]}

Hashimoto, Koshi ^{[1
]}

Mori, Masatomo ^{[1
]}

Okada, Shuichi ^{[1
]}

Satoh, Tetsurou ^{[1
]}

Yamada, Masanobu ^{[1
]}

机构：

[1] Gunma Univ, Grad Sch Med, Dept Med & Mol Sci, 3-39-15 Showa Machi, Maebashi, Gunma 3718511, Japan

来源：

ENDOCRINE JOURNAL | 2018年 / 65卷 / 05期

基金：

日本学术振兴会;

关键词：

Continuous glucose monitoring (CGM); Hypoglycemia; Adrenal insufficiency; Central hypoadrenalism; Glucocorticoid replacement therapy; MODIFIED-RELEASE HYDROCORTISONE; PRIMARY ADRENAL INSUFFICIENCY; ADDISONS-DISEASE; NOCTURNAL HYPOGLYCEMIA; PLASMA-CORTISOL; DIAGNOSIS; EXPOSURE; QUALITY; PROFILE; SYSTEM;

D O I：

10.1507/endocrj.EJ16-0387

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Patients with adrenal insufficiency require appropriate glucocorticoid replacement therapy; however, reliable biological parameters for optimizing glucocorticoid supplementation are limited. The physician has to rely primarily on clinical judgment, carefully taking into account signs and symptoms potentially suggestive of over- or under-replacement. We have found that some patients who are viewed as receiving sufficient doses of glucocorticoids occasionally exhibit morning headache or morning discomfort, which may be caused by unrecognized nocturnal hypoglycemia. Our aim in this study was to evaluate the usefulness of continuous glucose monitoring (CGM) for detecting unrecognized hypoglycemia and optimizing glucocorticoid replacement therapy in adult patients with central hypoadrenalism. Six patients with central hypoadrenalism of various etiologies were included in this study. All patients exhibited occasional morning headache or discomfort. We performed CGM to measure plasma glucose levels in all patients, and CGM identified unrecognized hypoglycemia episodes at midnight and early in the morning in five patients (83%). The CGM findings were used to fine-tune the dosing and regimens of glucocorticoid replacement and to re-evaluate glucose levels to avoid further unrecognized hypoglycemic events. This optimization of hydrocortisone supplementation prevented additional nocturnal hypoglycemia incidences in all cases. The addition of L-thyroxine with hydrocortisone continued to provide favorable glycemic control. Occasional symptoms also improved alter maintenance in all patients. These findings demonstrated that CGM may represent a powerful tool for identifying unrecognized hypoglycemia and for optimizing supplementary hormones in patients with central hypoadrenalism, thereby improving their quality of life.

引用

页码：547 / 556

页数：10

共 32 条

[1] Quality of glucocorticoid replacement in adrenal insufficiency:: clinical assessment vs. timed serum cortisol measurements [J].