Effect of Cortisol on Physical Exertion in Patients With Primary Adrenal Failure
NCT ID: NCT01847690
Last Updated: 2013-12-02
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.
UNKNOWN
PHASE2
20 participants
INTERVENTIONAL
2013-06-30
2014-03-31
Brief Summary
Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.
Detailed Description
Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.
Using a combination of oxygen uptake measurements under controlled exercise and assay of hormones and metabolites, we aim to test whether extra doses of hydrocortisone can increase physical capacity and reduce post-exertion fatigue. Each patient perform two tests, one with and one without hydrocortisone in randomised order. The controls perform one test. The patients will be assigned a participation number and randomised to any of two treatment sequences (A-B or B-A) by pharmacy. All exercise tests will be performed 3-5 hours after intake of morning medication, after an overnight fast (water permitted). Patients will be instructed to avoid caffeinated food and drink, alcohol, strenuous exercise and starvation for at least 24h before each exercise session. Patients will be instructed to avoid smoking, brush teeth one hour before exercise testing.
One hour before each test, subjects drink one teaspoon of water per kilogram body weight to provide adequate hydration. Stress-dose or placebo will be taken 60 min before start. Also at this time, an indwelling line will be placed in the forearm of each subject that blood and saliva can be drawn before, directly after exercise, then 15 or 30 min after termination of exercise. Patients fill out the questionnaire about quality of life after each exercise.
Patient's daily glycemic profile will be followed up by continuous glucose monitoring systems for 24 hours before, during and for 24 hours after exercise. Patients will be educated in using the sensor and calibration with blood glucose self-measurements three to four times per day. Calibration of the sensor will be performed according to the protocol established. At the completion of the measuring period, the system will be returned, and the data will be downloaded to determine glucose patterns. This device will be applied to the abdomen of each subject, 24 h before each exercise session, calibrated as recommended (before operation and 2-3 additional times/day, 6 h apart over the 24 h of the study) and removed 24 h after the exercise session.
The patient's movements will be followed for 24 hour by Actigraph after each test. The test is repeated after 1 week with the opposite treatment option.
Ten adult patients (18-70 years) with verified Addison's disease will be invited to participate in the study. From a list of patients (consecutive out-patients or a patient registry) unselected patients should be invited to participate. Five age and sex matched healthy controls will be included to assess normal metabolic and endocrine responses to physical activity.
The investigator will keep a log of all patients that have been invited to participate in the study. If a screened patient does not fulfil the inclusion criteria, the reason will be documented on a screening log. Eligible patients who fulfil all of the inclusion criteria and none of the exclusion criteria will be randomised. Randomization will be performed by the hospital pharmacies at each study site. When a subject is randomized, he or she must always be assigned to the lowest available randomization number. The patients will be randomised in blocks of two to secure even patient number in each treatment sequence.
The patient will have to give written informed consent. The patients should not take grapefruit juice, liquorice and do not be on a special diet the last two weeks before or during the study period. Patients will be instructed to avoid caffeinated food and drink, alcohol, strenuous exercise and starvation for at least 24 h before each exercise session. Patients will be instructed to avoid smoking at least one hour before each exercise session.
Withdrawal criteria/Adverse Events. The patient is free to withdraw at any time. If a patient is having major difficulties managing the exercise the investigator will consider withdrawal. In the best interest of the patient, the investigator and the sponsor can decide to withdraw the patient from the study. If a patient develops conditions meeting the exclusion criteria, the patient will be withdrawn from the study. In case of serious adverse events the patient may be withdrawn from the study.
Any adverse event will be registered and reported to the Norwegian Medicines Agency. Any serious adverse events will be reported within 15 days, and in case of lethal or life threatening events immediately. The patients will report any problems or discomfort during or after examination in the patient log or diary, any need for extra doses during the study day after exercise with glucocorticoids will also be documented there. In addition, we ask them to contact the study group directly in case of problems between visits. The study documentation and research date will be stored 15 years after the termination of the study.
Statistical considerations This is a pilot study to evaluate the effect stress-dosing of cortisol on physical capacity. The results will be used for statistical calculations of effect size for a larger trial. The variation of the various efficacy parameters in this group of patients is not well known.
Conditions
See the medical conditions and disease areas that this research is targeting or investigating.
Keywords
Explore important study keywords that can help with search, categorization, and topic discovery.
Study Design
Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.
RANDOMIZED
CROSSOVER
TREATMENT
DOUBLE
Study Groups
Review each arm or cohort in the study, along with the interventions and objectives associated with them.
Placebo
Treatment B is placebo (2 placebo tablets).
No interventions assigned to this group
Hydrocortisone
Treatment A is 10 mg hydrocortisone (2 tablets Cortef, 5 mg each),Stress-dose will be taken per os one time 2 tablets 10 mg of Cortef 60 min before start of exercise. Cortef tablets 5 mg produced by Pharmacia and Upjohn . One day.
Hydrocortisone
Cortef 5 mg tablets per os, 2x5 mg, one day, one time
Interventions
Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.
Hydrocortisone
Cortef 5 mg tablets per os, 2x5 mg, one day, one time
Other Intervention Names
Discover alternative or legacy names that may be used to describe the listed interventions across different sources.
Eligibility Criteria
Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.
Inclusion Criteria
Exclusion Criteria
* malignant disease
* pregnant women
* cardiac disease
* lung disease
* neuromuscular diseases
* pharmacological treatment with glucocorticoids or drugs that interfere with cortisol metabolism (anti-epileptics, rifampicin, St Johns wart, oral estrogens, antidepressives).
18 Years
70 Years
FEMALE
Yes
Sponsors
Meet the organizations funding or collaborating on the study and learn about their roles.
Haukeland University Hospital
OTHER
Responsible Party
Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.
Principal Investigators
Learn about the lead researchers overseeing the trial and their institutional affiliations.
Eystein Husebye, Professor
Role: STUDY_DIRECTOR
Haukeland University Hospital
Katerina Simunkova, MUDr. PhD
Role: PRINCIPAL_INVESTIGATOR
Haukeland University Hospital
Locations
Explore where the study is taking place and check the recruitment status at each participating site.
Haukeland Universitetessykehus, Department of Medicine
Bergen, Norway, Norway
Countries
Review the countries where the study has at least one active or historical site.
References
Explore related publications, articles, or registry entries linked to this study.
Neary N, Nieman L. Adrenal insufficiency: etiology, diagnosis and treatment. Curr Opin Endocrinol Diabetes Obes. 2010 Jun;17(3):217-23. doi: 10.1097/MED.0b013e328338f608.
Weise M, Drinkard B, Mehlinger SL, Holzer SM, Eisenhofer G, Charmandari E, Chrousos GP, Merke DP. Stress dose of hydrocortisone is not beneficial in patients with classic congenital adrenal hyperplasia undergoing short-term, high-intensity exercise. J Clin Endocrinol Metab. 2004 Aug;89(8):3679-84. doi: 10.1210/jc.2003-032051.
Wurtman RJ, Axelrod J. Control of enzymatic synthesis of adrenaline in the adrenal medulla by adrenal cortical steroids. J Biol Chem. 1966 May 25;241(10):2301-5. No abstract available.
Ehrhart-Bornstein M, Bornstein SR. Cross-talk between adrenal medulla and adrenal cortex in stress. Ann N Y Acad Sci. 2008 Dec;1148:112-7. doi: 10.1196/annals.1410.053.
Bornstein SR, Breidert M, Ehrhart-Bornstein M, Kloos B, Scherbaum WA. Plasma catecholamines in patients with Addison's disease. Clin Endocrinol (Oxf). 1995 Feb;42(2):215-8. doi: 10.1111/j.1365-2265.1995.tb01866.x.
Green-Golan L, Yates C, Drinkard B, VanRyzin C, Eisenhofer G, Weise M, Merke DP. Patients with classic congenital adrenal hyperplasia have decreased epinephrine reserve and defective glycemic control during prolonged moderate-intensity exercise. J Clin Endocrinol Metab. 2007 Aug;92(8):3019-24. doi: 10.1210/jc.2007-0493. Epub 2007 May 29.
Weise M, Mehlinger SL, Drinkard B, Rawson E, Charmandari E, Hiroi M, Eisenhofer G, Yanovski JA, Chrousos GP, Merke DP. Patients with classic congenital adrenal hyperplasia have decreased epinephrine reserve and defective glucose elevation in response to high-intensity exercise. J Clin Endocrinol Metab. 2004 Feb;89(2):591-7. doi: 10.1210/jc.2003-030634.
Merke DP, Chrousos GP, Eisenhofer G, Weise M, Keil MF, Rogol AD, Van Wyk JJ, Bornstein SR. Adrenomedullary dysplasia and hypofunction in patients with classic 21-hydroxylase deficiency. N Engl J Med. 2000 Nov 9;343(19):1362-8. doi: 10.1056/NEJM200011093431903.
Related Links
Access external resources that provide additional context or updates about the study.
endocrine society
Other Identifiers
Review additional registry numbers or institutional identifiers associated with this trial.
2012-005117-40
Identifier Type: EUDRACT_NUMBER
Identifier Source: secondary_id
2012/2216
Identifier Type: -
Identifier Source: org_study_id