| Objective:To evaluate the effect between hydrocortisone and prednisone steroid of postoperative hormone replacement for Cushing’s syndrome, evaluate the clinical significance of hydrocortisone in hormone replacement therapy.Methods:This study included45case of Cushing’s syndrome which had been diagnosed preoperative in our hospital during October2010to June2013, including two patients were lost contact, one case of adrenal cortical carcinoma patients were death after operation, the final42patients were enrolled in the study and complete statistics analysis. The patients were randomly divided into two groups:the prednisone group has20patients; the hydrocortisone group has22patients. two groups of patients were all underwent laparoscopic adrenal surgery and simplified hormone replacement therapy:No hormone was used before the operation,100mg hydrocortisone should be given by intravenous injection during operation, then100mg Q12h and100mg hydrocortisone given on the next two days after operation, and then starting oral steroid from on the second day. Prednisolone group oral prednisolone10mg (tid), thenfollowed by a reduction5mg every one week untile a maintenance dosage was reached and eventually withdrawal; according to the same amount of hormones transform, hydrocortisone group oral hydrocortisone40mg (tid), and final withdrawal in the same way. The clinical symptoms, blood pressure and heart rate were observed, the concentration of plasma cortisol and24h urine cortisol were intermittently measured on1st,2nd,6th,7th day and1st,3rd,6th month after operation by telephone follow-up and analysis of questionnaires way. Using statistical methods to analyze the changes of two group patients after the relevant clinical indicators, finding out dynamic changing trend.Result:1. Two groups of patients were all underwent laparoscopic adrenalectomy, All operations were successfully without convertion to open surgery.The average operation time was86.9min and intraoperative blooding loss was39.05ml,without blooding, without mortality; The average hospitalization after operative was7.71days; The successful rate of surgical was100%.2. Two groups of patients were all given the simplified hormone replacement therapy after operation. All patients had no adrenocortical insufficiency during the perioperative period with blood and24h urine cortisol were normal or above normal.3. During the period of hormone replacement therapy,35%of the prednisone group had adrenal insufficiency phenomenon, the durition of hormone replacement was4.85months.45.45%hydrocortisone group had adrenal insufficiency phenomenon, the durition of hormone replacement was6.55months. Two patients with severely symptoms requiring hospitalization, the other were all completely remiss after increasing oral dose.4. The general trendency of postoperative blood and urinary cortisol was basically same between the two groups; The hydrocortisone group patients’s was slightly lower than prednisone group at1st and3rd months after the operation, while slightly higher than prednisone group at6th months after the operation, but the postoperative changes was no significant (P>0.05).5. The general tendency of heart rate and blood pressure was basically same after operation showing downward trendency; following up six month after operation,66.67%hypertention patients of prednisone group became normal;63.16%hypertention patients of hydrocortisone group became normal; but the difference between two groups was no significant (P>0.05).6. The general tendency of serum sodium, potassium after opertion were basically same. The level of serum sodium showed slowly decining, while the serum potassium level showed slowly rising, the serum sodium of hydrocortisone group at1st,3rd,6th month after operation were higher than the same point of prednisone group, while the serum potassium were lower, but the difference between two groups was no significant (P>0.05); There are six patients of hydrocortisone group with inordnately edema, whose electrolyte examination revealed high sodium and low potassium at the same day, the symptoms would remission after symptomatic treatment of oral diuretic and swelling; six patients found hypokalemia and should be assisted potassium treatment.7. The general tendency of blood glucose showed slow decline and generally lower than preoperation; every blood glucose of hydrocortisone group were lower than prednisone group, but the difference was no significant (P>0.05). Following up six months,54.55%patients of prednisone group with abnormal glucose returned to norma,70%of patients of hydrocortisone group with abnormal blood glucose return to normal.The improvement of blood glucose of hydrocortisone group were better slightly than prednisone group, but the difference was no significant (P>0.05).8. In this study,35.71%of patients had abnormal liver function.28.57%patients with abnormal liver function returned to normalin prednisone group at six month after operation;87.5%abnormal liver function returned to normal in hydrocortisone group; the improvement of patients with abnormal liver in hydrocortisone group was more significantly than prednisone group (P<0.05).9. Two groups of patients were followed up for six months, The clinical symptoms of all patients has varying improved. Generally, the improvement score of clinical symptoms and mental symptoms in hydrocortisone group were slightly better than prednisone group. But the difference was no significant (P>0.05).Conclusions:1. Laparoscopic adrenalectomy has become standard treatment for most of adrenocortical adenoma with less trauma and quicker recovery.2. The simplification of hormone replacement therapy in our hospital is brief, safe and effective. It is a kind of practical solution for Cushing’s syndrome.3. The24h urine cortisol concentration can better reflect the adrenocorical function than the plama cortisol concentration.4. Hydrocortisone oral formulation can also be used for postoperation hormone replacement therapy for Cushing’s syndrome safely and effectively.5. Hydrocortisone has the advantages of absorbing quicker, effecting faster, weaker inhibitory effect on the HPA axis and fewer adverse reactions as a short acting hormone hydrocortisone. 6. Cushing’s syndrome patients should reduce the dosage slowly according to the patient’s clinical symptoms and related test results during the postoperative hormone replacement therapy, when patients confronted with fever, surgery, emotional and other emergency situations, the dosage should be increased to prevent adrenal insufficiency occurring. The course of hydrocortisone hormone replacement therapy was slower than prednisone.7. Patients with abnormal blood glucose or abnormal liver function, especially abnormal liver function, should chose hydrocortisone as the first choice during hormone replacement therapy in order to achieve better results.8. Hydrocortisone has a certain water and sodium retention, the clinical symptoms and electrolyte changes should be observed closely during replacement therapy, If you found the body edema, it has prompted some sodium and water retention, the appropriate potassium diuretic treatment should be given timely, then the symptoms would be alleviated. |
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