Endocrine Abstracts

Objective: There is evidence that current replacement regimens fail to restore well-being in patients with adrenal insufficiency (AI). No data is available on the effect of different therapeutical regimes (hydrocortisone, prednisolone, cortisone acetate) on the quality of life in these patients.

Methods: About 883 patients with adrenal insufficiency were contacted, 526 patients participated (60%) and received a disease specific questionnaire and three standardized questionnaires (SF36, GBB24 and HADS). Reference data for SF-36 scores were obtained from the German National Health Survey comprising a representative random sample of 7124 subjects from the German population aged 18–79 years. Reference data for the GBB-24 (n=2076) and HADS (n=2081) were obtained from surveys performed by Brahler and colleagues. Finally, 428 patients (232 primary AI, 196 secondary AI) were analyzed regarding their glucocorticoid replacement therapies.

Results: Health related quality of life was impaired in both primary and secondary AI compared to age- and sex-matched controls. No significant differences in symptoms and complaints assessed by GBB24 were seen between hydrocortisone (n=347), prednisolone (n=62), and cortisone acetate (n=19) treatment. Anxiety and depression scores assessed by HADS indicated no significant differences between the treatments in all patients. However, the depression score was significantly (P<0.05) lower in patients with primary AI on prednisolone compared to hydrocortisone therapy. Symptoms and complaints assessed by SF36 did not show significant differences between the treatments in all patients. But in patients with primary AI, the score of bodily pain was significantly lower (P<0.01) in patients on prednisolone compared to hydrocortisone or cortisone acetate therapy.

Conclusion: Health related quality of life is impaired in patients with primary or secondary AI. Different glucocorticoid replacement therapies did not show differences in quality of life except in patients with primary AI regarding depression and bodily pain. These results suggest a need for improved glucocorticoid replacement strategies.