Endocrine Abstracts

Background: Patients with adrenal insufficiency (AI) exhibit increased morbidity, mortality and impaired quality of life (QoL) and conventional hydrocortisone replacement does not mimic the endogenous circadian pattern and may compromise adherence. A modified – release hydrocortisone formulation (Plenadren) for once-daily use is licensed in order to meet these needs.

Objective: To audit the effects of treatment change from HC to Plenadren in an out-patient, daily-life clinical setting.

Patients and methods: Fifteen consecutive patients with AI and problems with adherence and/or QoL were shifted from HC to Plenadren treatment. The effect of treatment was assessed by clinical biochemistry, DEXA scanning and QoL (AddiQol) before and after 6 months.

Results: Fifteen patients (10F/5M) were included in the audit of whom 8 had primary AI with a mean age of 49.5 years. The mean daily HC dose was 21.4 mg and the mean daily plenadren dose was 20 mg. No significant changes were recorded in fasting lipid levels, morning salivary cortisol, serum electrolytes, HbA1c, or CRP before and after plenadren treatment. Likewise, body composition and BMD were unchanged. The AddiQol questionnaire showed a trend towards improved sleep, less muscle pain and better concentration at 6 months. Fourteen of the 15 patients continued on Plenadren after 6 months.

Conclusion: Plenadren treatment for 6 months in patients with AI was well received but did not translate into detectable changes in clinical biochemistry or body composition. Longer treatment duration and a larger patient group are needed to evaluate the long term benefit of plenadren.