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Where Can I Learn More about the Cortisol Pump?

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The following sources were used in the production of this guide, and are valuable educational resources for pumpers and medical providers alike. There is a wealth of information already available, and no doubt there will be much more in the coming years as cortisol pumping becomes more widely used.

Barola, A., Tiwari, P., Bhansali, A., Grover, S., & Dayal, D. (2018). Insulin-Related Lipohypertrophy: Lipogenic Action or Tissue Trauma? Frontiers in Endocrinology9. doi: 10.3389/fendo.2018.00638

CSHI yielded a smooth circadian cortisol curve, with mean serum cortisol within the reference range for healthy individuals at all time points, including the physiological late-night cortisol surge.

(Bjornsdottir et al 2013)

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 therapyEndocrine Abstracts. doi: 10.1530/endoabs.32.p9

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 et al, 2015)

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.

This case report demonstrates that CSHI is a feasible treatment option in children and young people with CAH, especially in the presence of abnormal hydrocortisone kinetics.

(Bryan et al, 2009)

Bryan, S. M., Honour, J. W., & Hindmarsh, P. C. (2009). Management of Altered Hydrocortisone Pharmacokinetics in a Boy with Congenital Adrenal Hyperplasia Using a Continuous Subcutaneous Hydrocortisone Infusion. The Journal of Clinical Endocrinology & Metabolism94(9), 3477–3480. doi: 10.1210/jc.2009-0630

Bryan, S. M., Honour, J. W., & Hindmarsh, P. C. (2009). Appendix of: Management of Altered Hydrocortisone Pharmacokinetics in a Boy with Congenital Adrenal Hyperplasia Using a Continuous Subcutaneous Hydrocortisone Infusion. The Journal of Clinical Endocrinology & Metabolism94(9), 3477–3480. doi: 10.1210/jc.2009-0630

During the following months, the patient experienced improvement of well-being with CSHI, with resolution of nausea and vomiting at wakening. She was also able to restart many of her home work and daily physical activities (including sport activities) that had been stopped after diagnosis of SAI.

(Cardini et al 2018)

Cardini, F., Torlone, E., Bini, V., & Falorni, A. (2018). Continuous subcutaneous hydrocortisone infusion in a woman with secondary adrenal insufficiency. Endocrine63(2), 398–400. doi: 10.1007/s12020-018-1780-4

Cellulitis. (2018, April 10). Retrieved from https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762.

Charmandari, E., Hindmarsh, P. C., Johnston, A., & Brook, C. G. D. (2001). Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency: Alterations in Cortisol Pharmacokinetics at Puberty. The Journal of Clinical Endocrinology & Metabolism86(6), 2701–2708. doi: 10.1210/jcem.86.6.7522

Charmandari, E. (2001). Congenital adrenal hyperplasia: management during critical illness. Archives of Disease in Childhood85(1), 26–28. doi: 10.1136/adc.85.1.26

Frequently Asked Questions. (n.d.). Retrieved from https://www.myomnipod.com/podder-support/faq.

Gagliardi, L., Nenke, M. A., Thynne, T. R. J., Borch, J. V. D., Rankin, W. A., Henley, D. E., … Torpy, D. J. (2014). Continuous Subcutaneous Hydrocortisone Infusion Therapy in Addisons Disease: A Randomized, Placebo-Controlled Clinical Trial. The Journal of Clinical Endocrinology & Metabolism99(11), 4149–4157. doi: 10.1210/jc.2014-2433

Altered patterns of glucocorticoid secretion occur in chronic disease states including major depression, obstructive sleep apnoea, and immune mediated arthritides.

(Gibbison et al, 2013)

Gibbison, B., Angelini, G., & Lightman, S. (2013). Dynamic output and control of the hypothalamic-pituitary-adrenal axis in critical illness and major surgery. British Journal of Anaesthesia111(3), 347–360. doi: 10.1093/bja/aet077

Hindmarsh, P. C., & Geertsma, K. (2017). Congenital adrenal hyperplasia: a comprehensive guide. London: Elsevier/Academic Press.

Insulin Pumps and Infections. (n.d.). Retrieved from http://www.diabetesforecast.org/2008/jan/insulin-pumps-and-infections.html.

Longman, J. (2019, August 29). IPX Ratings Explained. Retrieved from https://www.audioreputation.com/ipx-ratings-explained/.

This study indicates that CSHI is feasible and well tolerated in patients with AD. The patients reduced their effective glucocorticoid doses without adverse reactions, tended to normalise ACTH levels and to improve subjective health scores.

(Løvås, Husebye, 2007)

Løvås Kristian, & Husebye, E. S. (2007). Continuous subcutaneous hydrocortisone infusion in Addison’s disease. European Journal of Endocrinology157(1), 109–112. doi: 10.1530/eje-07-0052

MiniMed™ 630G Insulin Pump System. (n.d.). Retrieved from https://www.medtronicdiabetes.com/products/minimed-630g-insulin-pump-system.

Our patients reported remarkable improvements in HRQoL and fatigue and this was the primary reason why most patients wished to continue CSHI at the conclusion of the trial….In summary, CSHI was a well-tolerated and safe modality of hydrocortisone replacement.

(Nella et al, 2016)

Nella, A. A., Mallappa, A., Perritt, A. F., Gounden, V., Kumar, P., Sinaii, N., … Merke, D. P. (2016). A Phase 2 Study of Continuous Subcutaneous Hydrocortisone Infusion in Adults With Congenital Adrenal Hyperplasia. The Journal of Clinical Endocrinology & Metabolism101(12), 4690–4698. doi: 10.1210/jc.2016-1916

CSHI safely brought ACTH and cortisol toward normal circadian levels without adversely affecting glucocorticoid metabolism in the way that OHC did. Positive effects on HRQoL were noted with CSHI, indicating that physiological glucocorticoid replacement therapy may be beneficial and that CSHI might become a treatment option for patients poorly controlled on conventional therapy.

(Øksnes et al, 2014)

Øksnes, M., Björnsdottir, S., Isaksson, M., Methlie, P., Carlsen, S., Nilsen, R. M., … Løvås, K. (2014). Continuous Subcutaneous Hydrocortisone Infusion versus Oral Hydrocortisone Replacement for Treatment of Addisons Disease: A Randomized Clinical Trial. The Journal of Clinical Endocrinology & Metabolism99(5), 1665–1674. doi: 10.1210/jc.2013-4253

Saxe. A. M. (1984). Implantable Infusion Pump in the Therapy of Canine Adrenal Insufficiency. Surgery, 96(6), 1048-1053.

The use of SCIH seems to have other positive effects. Despite of therapy’s constraints, we noticed an increase in our patient’s well-being through the prospectively observed progression ofSF36 health score. Upon morning rise, he was dynamic and stayed active in his daily tasks. A decreased quality of life in patients with Addison’s disease or CAH is well known [12]. The influence of the mode of the hydrocortisone replacement has been noted [13]. Thus, SCIH therapy capable of mimicking the natural circadian cortisol production seems to be the best hydrocortisone delivery mode enhancing quality of life.

(Sonnet et al, 2011)

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 Endocrinology2011, 1–4. doi: 10.5402/2011/219494

Summer-Friendly Tandem Pump Features. (n.d.). Retrieved from https://www.tandemdiabetes.com/blog/post/general/2017/07/13/summer-friendly-tandem-pump-features.

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