Endocrine Abstracts

Introduction: Optimal glucocorticoid (GC) replacement in patients with adrenal insufficiency (AI) is desirable for the prevention of long-term side effects of GC. Both hyperglycemia and hypoglycemia are the risk of atherosclerosis. For the determination of optimal GC replacement method in patients with AI, we tested a utility of continuous glucose monitoring (CGM).

Subjects and methods: Three patients with primary or secondary AI were examined. Case 1, 50 yo female with complete AI because of bilateral adrenalectomy due to bilateral adrenal pheochromocytomas; Case 2, 50 yo male who showed asymptomatic or latent AI due to Rathke’s pouch as evidenced by relatively poor response to CRH.; Case 3, 64 yo male of partial panhypopituitarism due to the operation of craniopharyngioma. Under the various regime of hydrocortisone (HC) or dexamethasone (Dex) replacement, the frequency of high (over 110 mg/dl) and low (below 70 mg/dl) blood glucose levels were evaluated by CGM.

Results: In the bilaterally adrenalectomized case 1, regime 1, po HC (20, 0, 10, 0 mg) or regime 2, HC (15, 0, 5, 0 mg) + po Dex 0.25 mg before sleep was tested. While midnight hypoglycemia was more frequent in regime 1, the frequency of daily hyperglycemia and midnight hypoglycemia were dramatically reduced in regime 2. In case 2 of latent AI, even 5 mg HC in the morning increased the frequency of hyperglycemia, leading to the cancellation of the medication. In case 3 of partial AI, regime 1 (15, 5, 10, 0), 2 (15, 10, 5, 0), 3 (15, 0, 10, 0), 4 (10, 5, 5, 0) and 5 (10, 0, 5, 0) were tested. No hypoglycemia was observed in any regimen and the lower the dose of HC, the lower the frequency of hyperglycemia.

Conclusion: CGM is useful for perusing the ideal method of GC replacement in patients with AI.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.