Endocrine Abstracts

Introduction: The classical replacement therapy for hypoadrenalism may expose patients to non-physiologic glucocorticoids levels with negative metabolic consequences. Up to now, one study demonstrated that, as compared to the classical treatment, a modified-release hydrocortisone (MRH), improves weight, blood pressure, glycaemic control and QoL in a 3-month follow-up period. Few data are available on the long-term persistence of these benefits.

Design/methods: Ten patients with Addison’s disease and seven with central hypocortisolism (mean±S.D., age 50.8±10.7 years, BMI 27.9±7.0 kg/m², 9M/8F) were enrolled in three Italian Endocrine Units. 12 patients were treated with cortisone acetate (30.2±10.9 mg/day), five patients with hydrocortisone (25±5 mg/day), with an inadequate control of the disease. 80% of patients reported fatigue. In all patients, after baseline evaluations, the classical therapy was replaced with MRH (20.3±1.2 mg/day). At 1, 3, 6, and 12 months after the therapy modification (mean follow-up: 8.8±4.2 months) we evaluated parameters of adrenal function, BMI, blood pressure, HbA1c levels, and symptoms of over- or under-treatment.

Results: MRH caused higher morning cortisol levels than the classical therapy (after 12 months: 20.7±6.5 μg/dl vs 13.2±3.5 μg/dl, P=0.012), but comparable UFC values (after 12 months: 29.1±14 μg/24 h vs 24.1±9.5 μg/24 h, P=0.299), confirmed at each evaluation. In Addisonian patients MRH did not influence ACTH levels over time (after 12 months: 175.8±215 pg/ml vs 150.6±157 pg/ml, P=0.781). Paired sample T-test showed that metabolic parameters did not change after 1, 3, and 6 months. The ten patients that completed the 12 months follow-up, showed a reduction of BMI (29.2±5.8 vs 28.3±5.2, P=0.027) and systolic (126±18 mmHg vs 115±18 mmHg, P=0.03) blood pressure, while HbA1c decreased in the two diabetic patients (8.1±0.7% vs 5.9±1.1%). 60% of patients showed an improvement of fatigue after 6 months (P=0.023) that persisted at 12 months.

Conclusion: In patients with hypoadrenalism, a 12 months treatment with MRH seems to improve some metabolic parameter and to reduce weakness.