Endocrine Abstracts

Introduction: Autoimmune Addison disease requires lifelong glucocorticoid and mineralocorticoid replacement. Optimal therapy is not standardized and must balance adequate hormone substitution with prevention of treatment-related complications.

Objective: Assessment of patients followed at our department: epidemiology, associated conditions, treatment, cumulative hydrocortisone dose and comorbidities.

Methods: Review of clinical records of patients currently followed at our department, diagnosed from 1975 until 2015. Statistical analysis using SPSS v. 23.0.

Results: A total of 27 records were evaluated, 17 were women, 10 men. Mean age at diagnosis was 32±9.7 years, mean follow-up 19.7±13.8 years. Disease duration was 20 or more years in 55.6%. Mean current age 51±13 years. The most frequently associated immune system disorder was autoimmune thyroiditis (42.3%). Regarding glucocorticoid replacement, 92.6% were treated with hydrocortisone (HC), 2 patients with prednisolone. Mean daily dose of HC 31.2±10.0 mg (range 5.0–47.5 mg). Mineralocorticoid replacement with fludrocortisone, mostly 0.1 mg/d. Osteoporosis/osteopenia was found in 33.3% (n=9), hypertension (HT) in 25.9% (n=7), diabetes in 14.8% (n=4), treatment for depression or anxiety in 40.7% (n=11) and dyslipidemia in 51.9% (n=14). Mean cumulative HC dose was higher in patients with osteoporosis/osteopenia and in those with HT, dyslipidemia and diabetes, although not reaching statistical significance. Tendency remained when adjusted for age.

Discussion and conclusion: Our sample shows a long follow-up time, associated with lifelong need of Endocrinology assessment. A significant number of patients developed comorbidities possibly related to long-term glucocorticoid therapy (osteoporosis, HT, dyslipidemia and diabetes). All of these were related to higher cumulative HC dose. Absence of statistical significance was likely due to sample size. To reduce the risk of complications, replacement therapy in autoimmune Addison disease should be individually adjusted and overtreatment avoided.