ECE2014 Poster Presentations Adrenal cortex (56 abstracts)
Circadian cortisol and GH profiles in patients with Addison's disease: a comparison of continuous subcutaneous hydrocortisone infusion with conventional glucocorticoid replacement therapy
Marianne Øksnes 1 , Sigridur Björnsdottir 2 , Magnus Isaksson 3 , Paal Methlie 1 , Roy Nilsen 4 , Olle Kämpe 3 , Anna-Lena Hulting 2 , Eystein Husebye 1 , Kristian Løvås 1 , Thomas Nyström 5 & Sophie Bensing 2,
1University of Bergen, Bergen, Norway; 2Karolinska Institutet, Stockholm, Sweden; 3University of Uppsala, Uppsala, Sweden; 4Centre for Clinical research Haukeland University Hospital, Bergen, Norway; 5Department of Clinical Science and Education, Sødersjukhuset, Stockholm, Sweden.
Background: Conventional glucocorticoid replacement therapy in patients with Addison’s disease (AD) is unphysiological with possible adverse effects on mortality, morbidity and quality of life. Physiological amounts of glucocorticoids are required for normal GH production and release and a chronically raised cortisol level, suppresses the secretion of GH with possible metabolic and cardiovascular consequences. The diurnal cortisol profile can likely be restored by continuous s.c. hydrocortisone infusion (CSHI). The aim of this study was to compare circadian hormone rhythms in conventional thrice-daily regimen of glucocorticoid replacement therapy (OHC) with CSHI treatment in AD patients.
Design, subjects, measurements: An open, randomized, two-period, 12-week crossover multicenter trial in Norway and Sweden. Ten AD patients were admitted for 24 h sampling of hormone profiles after 8-week of CSHI and OHC. We measured the circadian rhythm of cortisol, ACTH, GH, IGF1 and IGF binding protein-3 (IGFBP-3) in patients who underwent OHC and CSHI treatment.
Results: The mean hydrocortisone dose was 0.34 mg/kg per day (0.10) and 0.30 (0.11) mg/kg per day for CSHI and OHC treatments, respectively. CSHI provided a more physiological circadian cortisol and ACTH curves including a late night cortisol surge. The expected nocturnal augmentation of GH release more pronounced for CSHI, and IGF1 and IGFBP3 levels tended to be higher with CSHI than with OHC.
Conclusion: Replicating the circadian cortisol rhythm with CSHI treatment could have beneficial metabolic effects beyond the normalization of ACTH levels, which should lead to further research in this area. The important nocturnal GH peak was preserved in both treatment groups but more pronounced in the CSHI group. In addition, the consistently higher IGF1 and IGFBP3 levels during morning hours suggest that CSHI provides a more anabolic and physiological nighttime state.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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