Sleep Medicine
Volume 8, Issue 5 , Pages 517-519, August 2007

Sleep improvement in an insomniac patient with global pituitary insufficiency after change from triple to quadruple cortisol replacement therapy

  • Ursula Voss

      Affiliations

    • Department of Psychology, J.W. Goethe-University Frankfurt/M, Germany
    • Corresponding Author InformationCorresponding author. Tel.: +49 69 4305079; fax: +49 69 79823457.
    • ,
  • Inka Tuin

      Affiliations

    • Department of Psychiatry, J.W. Goethe-University Frankfurt/M, Germany
    • ,
  • Karsten Krakow

      Affiliations

    • Department of Neurology, J.W. Goethe-University Frankfurt/M, Germany

Received 1 August 2006; received in revised form 1 September 2006; accepted 1 September 2006.

Abstract 

Although cortisol has a distinct circadian rhythm, patients with adrenal insufficiency usually receive diurnal hydrocortisone replacement therapy (HRT), disregarding possible consequences for sleep quality. The case reported here concerns the resolution of severe insomnia in a patient with global hypopituitary insufficiency upon adjustment of triple HRT to quadruple HRT. The data show a strong influence of cortisol on total sleep time and slow wave sleep (SWS) as well as rapid eye movement (REM) sleep. Clinically, the data are suggestive of the need to assimilate HRT to the natural circadian cortisol rhythm and not restrict it to the active part of the day.

Keywords: SWS, REM sleep, Insomnia, HPA, Cortisol, ACTH

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PII: S1389-9457(06)00609-5

doi:10.1016/j.sleep.2006.09.002

Sleep Medicine
Volume 8, Issue 5 , Pages 517-519, August 2007

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