Endocrine Abstracts

In primary adrenal insufficiency hydrocortisone or cortisone are commonly used at doses of 30–37.5 mg/day as replacement therapy, though recent studies showed that cortisol normal production is about 5.7 mg/m², equivalent to 20 mg/day of hydrocortisone, suggesting that supraphysiological doses are used. In 19 Addison’s disease patients (8 M, 11 F, 23–71 yr) under conventional glucocorticoid replacement therapy (37.5 mg cortisone/day) with low DHEAS levels, BMI, fasting glucose and insulin, glucose response to OGTT, cholesterol, triglycerides (TG), homocysteine, calcium, phosphate, PTH, 25OH-vitaminD, bone formation and resorption markers as well as intima-media thickness (IMT) by eco-doppler ultrasonography, bone mineral density (BMD) by a DEXA and vertebral morphology by spinal radiograph were measured. Mean BMI was in the upper range of normal, though higher than 25.0 kg/m² in 8 patients; mean fasting glucose, insulin, HOMA as well as glucose response to OGTT were normal, though HOMA were high in 5 patients; mean lipid profile was in the normal range; none of the patients had low HDL levels, whereas LDL and TG were higher than normal in 3 patients. Homocysteine was normal, though high in 5 patients. IMT was below 0.9 mm in all patients. Decreased mean BMD was found (T score <−1.0), while osteoporosis (<−2.5) was present in 2 eugonadal men and 3 postmenopausal women, vertebral fractures were found in 1 osteopenic and 1 osteoporotic patient. Mean calcium, phosphate, PTH, 25OH-vitaminD and osteocalcin were in the normal range, whereas urinary cross-laps were higher than normal. In conclusion, our preliminary results suggest that conventional glucocorticoid replacement therapy, associated with low DHEAS levels do not have a significant impact on glico-lipidic metabolism in patients with primary hypocortisolism, even in presence of slight overweight. On the other hand, increased risk of bone loss and vertebral fractures is confirmed in these patients.