Pharmacokinetics of Glucocorticoid Replacement Before and After Bariatric Surgery in Patients With Adrenal Insufficiency
Pharmacokinetics of Glucocorticoid Replacement Before and After Bariatric Surgery in Patients With Adrenal Insufficiency
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DOI：
10.1210/js.2018-00239
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发表时间：
2018-12-01
影响因子：
4.1
通讯作者：
de Boer, Hans
中科院分区：
文献类型：
--
作者：
de Heide, Loek J. M.;de Boer, Hannah H. R.;de Boer, Hans
原发性或继发性肾上腺功能不全患者适当的糖皮质激素替代对维持总体健康至关重要。我们对减肥手术对糖皮质激素吸收的影响知之甚少。本研究评估了5例因原发性（n = 1）或继发性（n = 4）肾上腺功能不全而接受糖皮质激素替代治疗的患者在减肥手术前后的糖皮质激素吸收情况，并评估了血浆皮质醇水平。1例患者行袖式胃切除术（SG）， 1例行单吻合式胃旁路术（mini-GB）， 3例行Roux-en-Y胃旁路术（RYGB）。药代动力学计算是基于在摄入早晨剂量后的前6小时进行的血浆皮质醇测量。手术前后血浆皮质醇谱非常相似；只观察到微小的差异。SG后血浆皮质醇峰值浓度和皮质醇曲线下面积（AUC）分别升高23%和24%，皮质醇峰值时间缩短10分钟。mini-GB对药动学参数无明显影响。在接受RYGB的3例患者中，AUC变化范围为-12%至20%。总之，在这一小部分肾上腺功能不全患者中，减肥手术前后血浆皮质醇谱相似。然而，鉴于个体对不同类型手术的反应存在差异，我们建议术后皮质醇分析来指导适当的糖皮质激素剂量调整。版权所有：2018年中国内分泌学会
Adequate glucocorticoid replacement in patients with primary or secondary adrenal insufficiency is essential to maintain general well-being. Little is known about the effects of bariatric surgery on glucocorticoid absorption. This study evaluates glucocorticoid absorption before and after bariatric surgery, with assessment of plasma cortisol profiles in five patients receiving glucocorticoid replacement therapy for primary (n = 1) or secondary (n = 4) adrenal insufficiency. One patient underwent sleeve gastrectomy (SG), one a one-anastomosis gastric bypass (mini-GB), and three a Roux-en-Y gastric bypass (RYGB). Pharmacokinetic calculations were based on plasma cortisol measurements performed during the first 6 hours after ingestion of the morning dose. Plasma cortisol profiles were very similar before and after surgery; only minor differences were observed. After SG, plasma peak cortisol concentration and cortisol area under the curve (AUC) were higher by 23% and 24%, respectively, and time to peak cortisol was 10 minutes shorter. The mini-GB had no marked effect on pharmacokinetic parameters. In the three patients who underwent RYGB, AUC changes ranged from -12% to 20%. In conclusion, in this small number of patients with adrenal insufficiency, plasma cortisol profiles were similar before and after bariatric surgery. However, in view of individual differences in response to different types of surgery, we recommend postoperative cortisol profiling to guide appropriate glucocorticoid dose adjustment. Copyright (C) 2018 Endocrine Society