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A cortisol pump is an insulin pump that has been filled with Solu-Cortef (hydrocortisone) instead of insulin. Users program the pump to match a healthy circadian rhythm of cortisol in order to better manage adrenal insufficiency.
Like an insulin pump, medication is delivered subcutaneously and continuously. This happens through a small cannula beneath the skin that is worn at all times.
Currently, no product is specifically labeled as a “cortisol pump.” But that does not negate the benefit the pump can bring to corticosteroid dependents. Many individuals using this method of treatment report improvement in quality of life.
The first instance of a insulin pump used to manage adrenal insufficiency was over 35 years ago. In 1984, a study was done trialing infusion pumps in dogs with adrenal insufficiency (Saxe 1984). The aim of the study was to determine if hydrocortisone infusion was a feasible way to manage adrenal insufficiency in humans. The study was considered successful: the dogs remained healthy during the treatment. But the limitations of insulin pump technology in the 1980s posed challenges in attaining natural circadian rhythm.
Continuous subcutaneous hydrocortisone infusion is a feasible, well-tolerated and safe treatment option in patients not able to tolerate oral preparations. It has the advantage of delivering hydrocortisone more efficiently, can mimic the normal diurnal cortisol rhythm and can reduce long-term complications. We propose to consider this form of treatment for selected patients with poor response to conventional therapy.(Broussard, Mitre 2015)
The pumping method was revisited more recently around 2003. This was to treat a patient with a form of primary adrenal insufficiency. This patient was found to have rapid metabolization and clearance of cortisol (Hindmarsh, Geertsma 2017 p. 359).
Cortisol pumping has since become more widely used because of the health benefits associated with restoring natural circadian rhythm (Bj€ornsdottir et al 2013). The cortisol pump has been described by researchers as “the best hydrocortisone delivery mode enhancing quality of life” (Sonnet et al 2011).
Find out more:
Bjornsdottir, S., Nystrom, T., Isaksson, M., Oksnes, M., Husebye, E., Lovas, K., … Bensing, S. (2013). Insulin sensitivity in patients with Addisons disease: a randomised cross-over trial comparing conventional glucocorticoid replacement therapy with continuous subcutaneous hydrocortisone infusion therapy. Endocrine Abstracts. doi: 10.1530/endoabs.32.p9
Broussard, Julia R., and Naim Mitre. “Successful Use of Continuous Subcutaneous Hydrocortisone Infusion after Bilateral Adrenalectomy Secondary to Bilateral Pheochromocytoma.” Journal of Pediatric Endocrinology and Metabolism, vol. 28, no. 7-8, Jan. 2015, doi:10.1515/jpem-2014-0473.
Hindmarsh, P. C., & Geertsma, K. (2017). Congenital adrenal hyperplasia: a comprehensive guide. London: Elsevier/Academic Press.
Saxe. A. M. (1984). Implantable Infusion Pump in the Therapy of Canine Adrenal Insufficiency. Surgery, 96(6), 1048-1053.
Sonnet, E., Roudaut, N., & Kerlan, V. (2011). Results of the Prolonged Use of Subcutaneous Continuous Infusion of Hydrocortisone in a Man with Congenital Adrenal Hyperplasia. ISRN Endocrinology, 2011, 1–4. doi: 10.5402/2011/219494