Time Adjustment of Hydrocortisone Doses During Shift Work in Patients with Adrenal Insufficiency.

A substantial proportion of patients with adrenal insufficiency working shifts reported difficulties taking glucocorticoid replacement therapy on time.

• Study population consisted of 15 patients working shifts from two German endocrine centers.
• 20% of patients stated they experience difficulties taking glucocorticoid replacement on time.
• 40% of patients reported these difficulties to occur only occasionally.
• Nearly half of the patients had forgotten to take their replacement therapy at some point.

More than half of the shift-working patients with adrenal insufficiency reported experiencing an adrenal crisis during the preceding two years.

• More than 50% of patients reported an adrenal crisis during the last two years.
• This finding was based on questionnaire responses from 15 shift-working patients with adrenal insufficiency.
• The questionnaire addressed therapy scheme, dose adaptations, working shifts, dose adaptations during working shifts, and occurrence of adrenal crisis.

The timely adaptation of hydrocortisone or modified-release hydrocortisone during shifts was very inhomogeneous across patients.

• No standardized or evidence-based adaptation scheme was identified among the 15 patients studied.
• Both immediate-release hydrocortisone and modified-release hydrocortisone formulations were represented in the patient population.
• The adaptation schemes were described as 'currently not evidence-based but opinion-driven.'

Shift work causes disruption between the circadian system and the external light-dark cycle as well as misalignment between various levels of the circadian system, posing a specific challenge for patients with adrenal insufficiency.

• No prior information existed on patients with adrenal insufficiency who are working shifts at the time of the study.
• Patients with adrenal insufficiency depend on timed exogenous hydrocortisone replacement to mimic normal cortisol circadian rhythmicity.
• The study used a questionnaire-based design administered to patients from two German endocrine centers.

The study identified a need for further investigations into hydrocortisone dosing strategies for shift workers with adrenal insufficiency.

• The sample size was small (n=15), limiting generalizability.
• Patients were recruited from two German endocrine centers.
• The authors concluded that current adaptation schemes are 'opinion-driven' rather than evidence-based, underscoring the gap in clinical guidance for this population.