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Horm Metab Res
DOI: 10.1055/a-2549-5784
Original Article: Endocrine Care

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

Tina Kienitz
1   Endocrinology, Endocrinology in Charlottenburg, Berlin, Germany
2   Department of Endocrinology and Metabolism, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
,
Christian Strasburger
2   Department of Endocrinology and Metabolism, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
,
Ulf Elbelt
3   Section Endocrinology/Diabetology, Medical Clinic B, Universitätsklinikum Ruppin-Brandenburg, Medizinische Hochschule Brandenburg,, Neuruppin, Germany
4   Endocrinology, Endokrinologikum Berlin, Berlin, Germany
,
Katharina Lang
1   Endocrinology, Endocrinology in Charlottenburg, Berlin, Germany
,
Knut Mai
2   Department of Endocrinology and Metabolism, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
5   Pituitary Tumor Center of Excellence at Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
6   Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
,
Thomas Bobbert
2   Department of Endocrinology and Metabolism, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
6   Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
,
Marcus Quinkler 
1   Endocrinology, Endocrinology in Charlottenburg, Berlin, Germany
› Author AffiliationsSupported by: Charité Clinician Scientist Program to Tina Kienitz
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Shift work causes a disruption between the circadian system and the external light-dark cycle, but also a misalignment between various levels of the circadian system. There is no information on patients with adrenal insufficiency (AI) who are working shifts. The objective of the study was to analyze the hormone replacement therapy with hydrocortisone (HC) and the adaptation scheme in patients with AI on shifts. Patients working on shifts (n=15) from two German endocrine centers received a questionnaire regarding their therapy scheme, dose adaptations, working shifts, dose adaptations during working shifts, and occurrence of adrenal crisis. We observed that 20% of patients stated that they experience difficulties taking glucocorticoid replacement on time, 40% of patients reported these difficulties to occur only occasionally. Consequently, nearly half of the patients had forgotten taking their replacement therapy at some point. More than 50% of patients reported adrenal crisis during the last two years. The timely adaptation of HC or of modified-release HC during shifts was very inhomogeneous. In conclusion, the adaptation schemes for HC dosing during shift work is currently not evidence-based but opinion-driven. Our findings highlight the need for further investigations of shift workers with AI.



Publication History

Received: 28 December 2024

Accepted after revision: 02 March 2025

Accepted Manuscript online:
02 March 2025

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