ReviewArchives of disease in childhood2017
Is physiological glucocorticoid replacement important in children?
Review in Archives of disease in childhood, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- Cortisol Levels During Acute Illnesses in Children and Adolescents: A Systematic Review.JAMA network open · 2022Pooled it
- Modified-Release Hydrocortisone in Congenital Adrenal Hyperplasia.The Journal of clinical endocrinology and metabolism · 2021Trial
- Modified-release hydrocortisone (EfmodyFrontiers in endocrinology · 2026Article
- PERSPECTIVE: Treatment with hydrocortisone modified-release capsules in children and adolescents with congenital adrenal hyperplasia: an expert opinion.Endocrine connections · 2025Review
- Extended-release Hydrocortisone Formulations-Is There a Clinically Meaningful Benefit?The Journal of clinical endocrinology and metabolism · 2025Review
- Immunophenotypic Implications of Reverse-Circadian Glucocorticoid Treatment in Congenital Adrenal Hyperplasia.International journal of molecular sciences · 2025Article
- Effects of glucocorticoid replacement therapy in patients with pituitary disease: A new perspective for personalized replacement therapy.Reviews in endocrine & metabolic disorders · 2024Review
- Glucocorticoids coordinate the bladder peripheral clock and diurnal micturition pattern in mice.Communications biology · 2023Article
- Approach to the Patient: Management of Pituitary Hormone Replacement Through Transition.The Journal of clinical endocrinology and metabolism · 2022Article
- Novel treatments for congenital adrenal hyperplasia.Reviews in endocrine & metabolic disorders · 2022Review
- Optimizing the Timing of Highest Hydrocortisone Dose in Children and Adolescents With 21-Hydroxylase Deficiency.The Journal of clinical endocrinology and metabolism · 2022Article
- Therapy options for adrenal insufficiency and recommendations for the management of adrenal crisis.Endocrine · 2021Review
- Health-related quality of life and fatigue perception in children with congenital adrenal hyperplasia: A Developing nation perspective.Pediatric endocrinology, diabetes, and metabolism · 2021Article
- Evidence for disruption of diurnal salivary cortisol rhythm in childhood obesity: relationships with anthropometry, puberty and physical activity.BMC pediatrics · 2020Article
- [Modified-release hydrocortisone for glucocorticoid deficiency].Der Internist · 2020Review
- Accuracy of hydrocortisone dose administration via nasogastric tube.Clinical endocrinology · 2019Article
- Novel insights into glucocorticoid replacement therapy for pediatric and adult adrenal insufficiency.Therapeutic advances in endocrinology and metabolism · 2019Review
- Metabolic Perspectives for Non-classical Congenital Adrenal Hyperplasia With Relation to the Classical Form of the Disease.Frontiers in endocrinology · 2019Review
- Predicting Cortisol Exposure from Paediatric Hydrocortisone Formulation Using a Semi-Mechanistic Pharmacokinetic Model Established in Healthy Adults.Clinical pharmacokinetics · 2018Article
- Monogenic Disorders of Adrenal Steroidogenesis.Hormone research in paediatrics · 2018Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Cortisol has a distinct circadian rhythm with low concentrations at night, rising in the early hours of the morning, peaking on waking and declining over the day to low concentrations in the evening. Loss of this circadian rhythm, as seen in jetlag and shift work, is associated with fatigue in the short term and diabetes and obesity in the medium to long term. Patients with adrenal insufficiency on current glucocorticoid replacement with hydrocortisone have unphysiological cortisol concentrations being low on waking and high after each dose of hydrocortisone. Patients with adrenal insufficiency complain of fatigue, a poor quality of life and there is evidence of poor health outcomes including obesity potentially related to glucocorticoid replacement. New technologies are being developed that deliver more physiological glucocorticoid replacement including hydrocortisone by subcutaneous pump, Plenadren, a once-daily modified-release hydrocortisone and Chronocort, a delayed and sustained absorption hydrocortisone formulation that replicates the overnight profile of cortisol. In this review, we summarise the evidence regarding physiological glucocorticoid replacement with a focus on relevance to paediatrics.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.