ECE2015 Guided Posters Adrenal (8 abstracts)
1Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Federico II University, Naples, Italy; 2Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; 3Section of Endocrinology and Metabolic Disease, DIBIMIS, University of Palermo, Palermo, Italy.
Adrenal insufficiency (AI) requires life-long glucocorticoid (GC) treatment, which is associated with an increased risk of metabolic syndrome (MS), probably due to cortisol overexposure for multiple drug daily doses, together with an impairment of quality of life (QoL). Moreover treatment compliance (TC) is reported to be suboptimal in AI patients. The current study aimed at investigating the impact of the switch from twice/thrice daily conventional GCs to once daily dual-release-hydrocortisone (DR-HC) treatment on metabolic profile, QoL and TC in patients with primary AI (PAI) and secondary AI (SAI). Thirty-five patients (12 with PAI (7F, 5M, 3360 years), eight treated with cortisone acetate (37.575 mg/day) and four with HC (2030 mg/day)) and 23 patients with SAI (9F, 14M, 2077 years), 15 treated with cortisone acetate (18.7537.5 mg/day) and eight with HC (1520 mg/day) entered the study and were evaluated before and 6 months after the switch to DR-HC (PAI: 2060 mg/day and SAI: 2040 mg/day). At 6-month-follow-up, in PAI patients, body weight (BW) (P=0.036) significantly improved and a trend to a significant improvement was also found for waist circumference (WC) (P=0.086). A diagnosis of MS, performed in two patients (17%) at baseline, was not confirmed after 6 months. In SAI patients, BW (P=0.001), BMI (P=0.003), and WC (P=0.007) significantly improved. A clear diagnosis of MS, performed in seven patients (30%) at baseline, was confirmed only in 4 (17%) of these patients after 6 months. In a subgroup of 12 patients with AI, visceral adiposity index (VAI), an indicator of adipose function and distribution, which seems to indirectly express the cardiometabolic risk, significantly improved (P=0.05) while an improvement in glucose levels (P=0.064) and in insulin sensitivity index (ISI 120) (P=0.052) was reported 120 min after glucose load. In the subgroup of ten patients considered for the evaluation of QoL and TC, working ability ameliorated in six patients (60%), vitality in 5 (50%), general health perception and depression in three patients (30%) and body pain perception in 2 (20%) patients. Moreover, 9 (90%) of these ten patients improved TC, changing from low to medium adherence. In conclusion, the switch from conventional GCs to DR-HC in patients with AI improved BW, BMI, WC, prevalence of MS, glucose tolerance and insulin sensitivity, QoL and TC.