Endocrine Abstracts

Introduction: During recent years many authors have advocated lower hydrocortisone doses in patients with primary adrenal insufficiency (PAI) mainly due to worries for non-physiological effects like increased cardiovascular risk and bone resorption, but very little attention has been drawn to fludrocortisone dosing. Our main hypothesis was that that the higher hydrocortisone dose, the lower the fludrocortisone dose and vice versa.

Design: The European Adrenal Insufficiency Registry (EU-AIR) sponsored by Shire with 20 centers in Germany, The Netherlands, Sweden and the UK started enrolling patients with AI in August 2012. At enrolment, comprehensive demographic and baseline data, etiology of PAI, details of glucocorticoid replacement therapy and safety data (intercurrent illnesses, adrenal crisis) are collected electronically. This report compares baseline data of PAI (including classic adrenal hyperplasia (CAH)) treated with hydrocortisone/cortisone acetate or the new modified release hydrocortisone tablet (Plenadren) given in lower doses ≤20 mg or doses >20 mg with regards to the dose of fludrocortisone.

Results: As of 5th November 2014, 345 patients with PAI, 50.1±15.7 years., 221 (64.1%) F, BMI <25 44.1%, 25–<30 30.4% and ≥30 18% (missing BMI data 7.5%), were registered in EU-AIR. The distribution of hydrocortisone-equivalent doses were: n=179 received ≤20mg, while n=166 received >20 mg (of those n=27 received >30 mg). The median fludrocortisone dose for all patients was 100 μg (range 0–300). No clear differences were found between gender, but a tendency to higher doses of fludrocortisone in males, if treated with hydrocortisone <20 mg, was found. On the other hand, increasing doses with fludrocortisone were slightly associated with higher BMI and with hydrocortisone doses >30 mg.

Conclusions: Our data shows that the fludrocortisone dose differs widely between patients. We could not demonstrate a general effect that higher hydrocortisone doses compensating the mineralocorticoid effect with correspondingly lower doses of fludrocortisone in PAI.

Disclosure: This work was sponsored by Shire.