Endocrine Abstracts

Introduction: Patients with primary adrenal insufficiency (PAI) require lifelong corticoids replacement and they are at risk of therapy-related osteoporosis and cardiovascular complications.

Objectives: Determine the prevalence of cardiovascular risk factors, osteoporosis, and other toxicities related with corticoids treatment.

Material and methods: Retrospective, descriptive study in patients with PAI follow up in our service during the last 30 years. Information was collected from clinical histories.

Results: Identified 30 patients with PAI. Clinical characteristics: 21 were women, mean age at diagnosis of 36.72±5.3 years and mean time since diagnosis 263.8±57.5 months. Etiology: 15 (50%) autoimmune disease; 7 (23.3%) post-surgery; 5 (16.6%) congenital adrenal hyperplasia; 2 (6.7%) tuberculosis and 1 (3.3%) metastatic disease.

Steroid replacement: 26 (86.7%) used hidrocortisone (HC), 3 (10%) dexametasone, 1 (3.3%) prednisone. 25 patients were on treatment with fludrocortisone. Mean glucocorticoid dose (HC or equivalent): 20.58±1.5 mg/day, mean fludrocortisone dose 0.066±0.008 mg/day.

Possible therapy-related complications: 23(76.7%) patients developed at least 1complication during follow-up: osteoporosis 11(36.7%), dyslipidemia 10 (33.3%), prediabetes 8(26.6%), hypertension 7(23.3%), type 2 diabetes 6(20%), 1(3.3%) cardiovascular event. 88% patients with osteoporosis, 78.6% with diabetes or prediabetes, 85.7% hypertension and 70% with dyslipidemia used HC dose ≥20 mg/d.

Conclusions: Osteoporosis and cardiovascular complications are frequents in patients with PAI. Patients on treatment with higher corticoid dose are at risk of development therapy-related complication. Adjustment in corticoid to minimal necessary dose could prevent these complications.