Sleep improvement in an insomniac patient with global pituitary insufficiency after change from triple to quadruple cortisol replacement therapy.

Abstract

Although cortisol has a distinct circadian rhythm, patients with adrenal insufficiency usually receive diurnal hydrocortisone replacement therapy (HRT), disregarding possible consequences for sleep quality. The case reported here concerns the resolution of severe insomnia in a patient with global hypopituitary insufficiency upon adjustment of triple HRT to quadruple HRT. The data show a strong influence of cortisol on total sleep time and slow wave sleep (SWS) as well as rapid eye movement (REM) sleep. Clinically, the data are suggestive of the need to assimilate HRT to the natural circadian cortisol rhythm and not restrict it to the active part of the day.

• Authors: Ursula Voss, Inka Tuin, Karsten Krakow
• Journal: Sleep medicine (Sleep Med) Vol. 8 Issue 5 Pg. 517-9 (Aug 2007) ISSN: 1389-9457 [Print] Netherlands
• PMID: 17512794 (Publication Type: Case Reports, Journal Article)

Chemical References

• Hydrocortisone

Topics

• Addison Disease (complications, drug therapy)
• Adult
• Circadian Rhythm (drug effects)
• Dose-Response Relationship, Drug
• Hormone Replacement Therapy (adverse effects)
• Humans
• Hydrocortisone (administration & dosage)
• Male
• Sleep Initiation and Maintenance Disorders (chemically induced, drug therapy)
• Sleep, REM (drug effects)
• Treatment Outcome