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The diurnal rhythm of the HPA axis is lost in Cushing’s diseasea syndrome of adrenocortical hyperfunction characterized by obesity with centripetal fat distributionthinning of the skin with easy bruisabilitymuscle wasting with weaknesshypertensionlatent diabetesosteoporosiselectrolyte imbalanceetcThe same clinical findings of hyperadrenocorticism may be noted during long-term pharmacologic dose corticoid therapy administered in conventional daily divided dosesIt would appearthenthat a disturbance in the diurnal cycle with maintenance of elevated corticoid values during the night may play a significant role in the development of undesirable corticoid effectsEscape from these constantly elevated plasma levels for even short periods of time may be instrumental in protecting against undesirable pharmacologic effects.
Sulfonylureas such as glipizide or glyburide biguanides such as metformin thiazolidinediones such as pioglitazone or rosiglitazone acarbose metiglinides such as nateglinide or repaglinide.
Typical starting dosageThis may vary from 5 mg to 60 mg per daydepending on the specific disease and person taking the drugFor immediate-release tablets onlyTo reduce side effectstwice the usual dose of this drug may be taken every other morningThis is called alternate day therapyDo not use alternate day therapy unless prescribed by your doctor.
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