Figure 14.

A, Comparison between 24-hour plasma cortisol profile typically achieved with optimal hydrocortisone replacement (10 mg upon awakening, 5 mg at lunch, and 5 mg at 7 pm [dinner]) in patients with adrenal insufficiency (dotted red lines) and normal cortisol levels from healthy young adults (shaded area) (data source, Refs. 313 and 416). B, Profile of circulating cortisol levels achieved by a single early morning administration of a modified-release oral hydrocortisone preparation (solid line) as compared to the profile resulting from immediate release hydrocortisone administered three times daily (dashed line). [Redrawn from G. Johannsson, et al: Improved cortisol exposure-time profile and outcome in patients with adrenal insufficiency: a prospective randomized trial of a novel hydrocortisone dual-release formulation. J Clin Endocrinol Metab. 2012;97(2):473—481 (416), with permission. © The Endocrine Society.] C, Example of a plasma cortisol profile obtained in a healthy subject in whom endogenous cortisol levels were suppressed by 5 days of metyrapone administration and replaced by sc hydrocortisone replacement via an infusion pump programmed to mimic circadian and pulsatile variations. [Adapted from G. M. Russell, et al: Subcutaneous pulsatile glucocorticoid replacement therapy. Clin Endocrinol (Oxf). 2014;81(2):289–293 (422), with permission. © Blackwell Scientific Publications.]