Endocrine Abstracts

Life-long glucocorticoid (GC) treatment is needed in patients with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency in order to replace cortisol deficiency and to control ACTH and consequently androgen levels. Therefore, patients with CAH tend to have an increased risk of metabolic syndrome (MS), probably due to cortisol overexposure, caused by multiple daily doses of conventional GCs, unable to mimic cortisol circadian rhythm. The current study aimed at investigating the impact of the switch from twice or thrice daily conventional GCs to once daily dual release hydrocortisone formulation (DR-HC) on metabolic and hormonal profile in a cohort of patients with CAH. Twenty-three patients (15 F, 8 M, 19–29 years) with CAH, chronically treated with hydrocortisone (15–40 mg/day) or prednisone (6.25–12.5 mg/day) and switched to DR-HC (10–40 mg/day) entered the study. Metabolic and hormonal parameters were evaluated before and after short- (3 months) and long-term (6 months) DR-HC treatment in the entire group of 23 and in a subgroup of 15 patients, respectively. The insulin resistance was evaluated by calculating the homeostasis model assessment of the insulin resistance index (HOMA-IR) whereas the MS was estimated in line with NCEP ATP III definition. At 3-month follow-up, fasting plasma glucose (P=0.004) and HDL-cholesterol (P=0.027) levels significantly improved. At 6-month follow-up, fasting plasma glucose (P=0.004) significantly improved and a trend to a significant improvement was registered for fasting serum insulin (P=0.074). Moreover, HOMA-IR also significantly improved (P=0.041); a clear diagnosis of MS was performed in one patient at the baseline, but this was not confirmed after 6 months of DR-HC treatment. No significant change in morning plasma ACTH, 17-OH progesterone and androgens levels and no clinical worsening of symptoms and signs related to hyperandrogenism were observed, but a significant increase in morning serum cortisol levels was registered both after short- and long-term follow-up. In conclusion, the switch from conventional GCs to DR-HC significantly improves metabolic parameters and insulin resistance, maintaining an optimal hormone control in patients with CAH due to 21-hydroxylase deficiency.