Endocrine Abstracts

Objective: There is evidence that current replacement regimens fail to restore well-being in patients with adrenal insufficiency. No data is available on the effect of twice or thrice daily administration of hydrocortisone 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, 282 patients on hydrocortisone therapy were grouped according their daily dose per body surface area (8–11 mg/BSA (n=93), 11–14 mg/BSA (n=128), 14–17 mg/BSA (n=61)) and analyzed regarding twice and thrice daily intake.

Results: In general, we observed a tendency towards better health related quality of life in patients taking hydrocortisone twice compared to thrice daily in all dose groups. The score of physical functioning as assessed by SF36 was significantly lower (P<0.008) and scores for exhaustion tendency, pain in the limbs and global score of discomfort assessed by GBB24 (P<0.05) were significantly higher in patients on a thrice daily intake compared to twice daily intake of 11–14 mg/BSA hydrocortisone indicating reduced health-related quality of life. However, anxiety and depression scores indicated no significant differences.

Conclusion: Health related quality of life tends to be impaired in patients on a thrice compared to a twice daily intake of hydrocortisone. It remains to be elucidated if a thrice daily intake is already a response of the physician to an impaired health status or if a thrice daily intake itself causes a reduced health related quality of life through mechanisms still unknown. Our results suggest a need for improved glucocorticoid replacement strategies.