Full Text View  
  Tabular View  
  Contacts and Locations  
  No Study Results Posted  
  Related Studies  
Research Study for Children With Salt Wasting Congenital Adrenal Hyperplasia
This study is currently recruiting participants.
Verified by Baylor College of Medicine, March 2008
Sponsored by: Baylor College of Medicine
Information provided by: Baylor College of Medicine
ClinicalTrials.gov Identifier: NCT00529841
  Purpose

The purpose of this study is to develop a more physiological approach to the management of children and adolescents with salt wasting Congenital Adrenal Hyperplasia.

We will administer the glucocorticosteroid via insulin infusion pump to see whether this treatment will improve the serum hormone concentrations.


Condition Intervention
Adrenal Hyperplasia, Congenital
Drug: Hydrocortisone sodium acetate

Genetics Home Reference related topics: 21-hydroxylase deficiency
MedlinePlus related topics: Dietary Sodium
Drug Information available for: Hydrocortisone Cortisol 21-phosphate Cortisol succinate Hydrocortamate Hydrocortisone 21-sodium succinate Hydrocortisone acetate Hydrocortisone cypionate Hydrocortisone hemisuccinate Proctofoam-HC Insulin Sodium chloride Epinephrine Epinephrine bitartrate Sodium acetate Acetic acid, sodium salt
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Open Label, Uncontrolled, Single Group Assignment, Efficacy Study
Official Title: A Novel Therapeutic Modality for Congenital Adrenal Hyperplasia

Further study details as provided by Baylor College of Medicine:

Primary Outcome Measures:
  • Serum 17-OHP concentration in the morning [ Time Frame: 11 days ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • serum steroid hormone profiles [ Time Frame: 11 days ] [ Designated as safety issue: No ]
  • serum blood glucose [ Time Frame: study days 2,3 and 11 ] [ Designated as safety issue: Yes ]
  • serum sodium [ Time Frame: study days 2,3 and 11 ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 10
Study Start Date: January 2007
Estimated Study Completion Date: July 2008
Estimated Primary Completion Date: August 2007 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1: Experimental
Subcutaneous administration of medication via insulin pump
Drug: Hydrocortisone sodium acetate
Subcutaneous administration of medication via insulin pump

Detailed Description:

The adrenal gland is a small organ of the body. It produces very important chemicals called hormones. One of these hormones, cortisol (the stress hormone) helps the body fight diseases. The other hormone is the aldosterone helps to maintain the normal amount of salt and water in the body. The third type of hormones are the androgens or male hormones, which cause some of the changes during puberty, like the growth of body hair and pimples.

The salt wasting Congenital Adrenal Hyperplasia or CAH disease is a disease of the adrenal gland. Patients with this disease cannot make cortisol or the aldosterone. As a result, their body cannot fight diseases and cannot keep normal amounts of salt and water in the body. At the same time, the gland makes too much of the male hormones, which is bad for the body because too much male hormone slows down growth, increases the growth of body hair, and causes pimples and abnormal period in girls.

Patients with this disease have to take medications every day. However, the treatment does not work very well, because usually the patients do not have the right amount of hormone in their body. Usually the body gets too much hormone right after taking the pills. A couple of hours later the body has too little of the hormones, because in the meantime the body gets rid of the medication.The healthy adrenal gland makes the hormones throughout the day in different amounts. The patients with this disease take the medication only a couple of times a day. They take the Florinef tablet once a day and the Cortisol tablet two or three times a day. The treatment that we use today by mouth cannot copy the natural hormone productions of the adrenal gland. Because of this it does not make much of a difference in the patient's life.

We would like to improve the treatment and find out the effect of a new treatment. In this study we will try to imitate the body's normal hormone production and will give the medication via an insulin pump to see if this treatment method will decrease the male hormones in the blood. This study will help us to develop a new and better treatment for children and adolescents.

  Eligibility

Ages Eligible for Study:   3 Years to 18 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Children with salt wasting CAH otherwise healthy without other chronic disease
  • Age: between 3 and 18 years of age
  • Body weight 23 kg (50 lbs) or above
  • Hemoglobin equal to or higher than 12 g/dl before the study
  • Supportive family environment

Exclusion Criteria:

  • Age less than 3 or older than 18 years at the time of study
  • Other chronic disease
  • Hemoglobin less than 12 g/dl
  • Non-supportive family
  • Allergy to local anesthetics

Criteria for study termination: If the subject's parents are unable to manage/operate the pump, the subject will be withdrawn from the study.

  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00529841

Contacts
Contact: Andrea E Balazs, MD 832-822-3773 aebalazs@texaschildrenshospital.org

Locations
United States, Texas
BCM, Texas Children's Hospital Clinic and General Clinical Research Center Recruiting
Houston, Texas, United States, 77030
Contact: Andrea E Balazs, MD     832-822-3773     aebalazs@texaschildrenshospital.org    
Principal Investigator: Morey W Haymond, MD            
Sub-Investigator: Andrea E Balazs, MD            
Sponsors and Collaborators
Baylor College of Medicine
Investigators
Principal Investigator: Morey W Haymond, MD Baylor College of Medicine
  More Information

Publications:
Esteban NV, Loughlin T, Yergey AL, Zawadzki JK, Booth JD, Winterer JC, Loriaux DL. Daily cortisol production rate in man determined by stable isotope dilution/mass spectrometry. J Clin Endocrinol Metab. 1991 Jan;72(1):39-45.
Kerrigan JR, Veldhuis JD, Leyo SA, Iranmanesh A, Rogol AD. Estimation of daily cortisol production and clearance rates in normal pubertal males by deconvolution analysis. J Clin Endocrinol Metab. 1993 Jun;76(6):1505-10.
Speiser PW. Toward better treatment of congenital adrenal hyperplasia. Clin Endocrinol (Oxf). 1999 Sep;51(3):273-4. No abstract available.
Gordon B.Cutler et al. Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency NEJM 1990 Vol 323, No 26, 1806-1813
Winterer J, Chrousos GP, Loriaux DL, Cutler GB Jr. Effect of hydrocortisone dose schedule on adrenal steroid secretion in congenital adrenal hyperplasia. J Pediatr. 1985 Jan;106(1):137-42.
Wallace WH, Crowne EC, Shalet SM, Moore C, Gibson S, Littley MD, White A. Episodic ACTH and cortisol secretion in normal children. Clin Endocrinol (Oxf). 1991 Mar;34(3):215-21.
Merza Z, Rostami-Hodjegan A, Memmott A, Doane A, Ibbotson V, Newell-Price J, Tucker GT, Ross RJ. Circadian hydrocortisone infusions in patients with adrenal insufficiency and congenital adrenal hyperplasia. Clin Endocrinol (Oxf). 2006 Jul;65(1):45-50.
Lukert BP. Editorial: glucocorticoid replacement--how much is enough? J Clin Endocrinol Metab. 2006 Mar;91(3):793-4. No abstract available. Erratum in: J Clin Endocrinol Metab. 2006 Jun;91(6):2073.
Claude J.Migeon. Can the Long Range Results of the Treatment of Congenital Adrenal Hyperplasia be improved? JCEM 1996 Vol 81, No 9 3187-3189
Laue L, Merke DP, Jones JV, Barnes KM, Hill S, Cutler GB Jr. A preliminary study of flutamide, testolactone, and reduced hydrocortisone dose in the treatment of congenital adrenal hyperplasia. J Clin Endocrinol Metab. 1996 Oct;81(10):3535-9.
Mah PM, Jenkins RC, Rostami-Hodjegan A, Newell-Price J, Doane A, Ibbotson V, Tucker GT, Ross RJ. Weight-related dosing, timing and monitoring hydrocortisone replacement therapy in patients with adrenal insufficiency. Clin Endocrinol (Oxf). 2004 Sep;61(3):367-75.

Responsible Party: Baylor College of Medicine ( Morey W.Haymond MD Professor of Pediatrics;Chief. Endocrine and Metabolism Section; Vice Chairman for Research )
Study ID Numbers: H-19704, GCRC # 0962
Study First Received: September 12, 2007
Last Updated: March 25, 2008
ClinicalTrials.gov Identifier: NCT00529841  
Health Authority: United States: Institutional Review Board

Keywords provided by Baylor College of Medicine:
Salt Wasting Congenital Adrenal Hyperplasia
Subcutaneous Hydrocortisone

Study placed in the following topic categories:
Hydrocortisone
Metabolic Diseases
Cortisol succinate
Gonadal Disorders
Adrenogenital Syndrome
Adrenal Gland Diseases
Endocrine System Diseases
Adrenocortical Hyperfunction
Sex Differentiation Disorders
Insulin
Metabolism, Inborn Errors
Hyperplasia
Adrenal hyperplasia
Genetic Diseases, Inborn
Adrenal Hyperplasia, Congenital
Hydrocortisone acetate
Endocrinopathy
Epinephrine
Metabolic disorder

Additional relevant MeSH terms:
Anti-Inflammatory Agents
Pathologic Processes
Therapeutic Uses
Steroid Metabolism, Inborn Errors
Pharmacologic Actions

ClinicalTrials.gov processed this record on January 15, 2009