Endocrine Abstracts

Introduction: The daily maintenance dose of conventional hydrocortisone currently recommended by international guidelines for the management of primary adrenal insufficiency (PAI) or secondary adrenal insufficiency (SAI) is 15−25 mg/day, in 2−3 divided doses. The aim of this analysis was to investigate inter-country differences in glucocorticoid replacement doses in patients with PAI and SAI.

Design: EU-AIR (ClinicalTrials.gov identifier: NCT01661387) with 20 contributing centres across Germany, the Netherlands, Sweden and the UK started enrolling patients with AI in August 2012. Baseline clinical and biochemical data from patients in the four countries were compared. 1798 patients (626 PAI, 1172 SAI) were included in the current analysis of data collated until November 2016. Patients with congenital adrenal hyperplasia or tertiary AI were excluded.

Results: No major differences between countries were seen in disease duration, BMI, blood pressure or blood lipids in patients with PAI and SAI. However, BMI was generally higher in patients with SAI than PAI. Most patients were treated with conventional hydrocortisone, with similar mean doses administered in Germany, the Netherlands, Sweden and the UK (PAI: 24.7±8.4 mg/day, 22.2±5.7 mg/day, 21.5±10.0 mg/day, 21.0±9.3 mg/day; SAI: 20.0±6.4 mg/day, 20.8±6.1 mg/day, 21.6±9.4 mg/day, 18.9±5.2 mg/day). Cortisone acetate was most commonly used in the Netherlands (PAI, 23%; SAI, 27%). No difference was observed in fludrocortisone dosing in patients with PAI between countries (0.1±0.07 mg/day, 0.1±0.04 mg/day, 0.1±0.05 mg/day, 0.1±0.12 mg/day). Patients with PAI treated with dual-release hydrocortisone (DRHC) were treated with lower doses in Germany 21.3±2.3 compared with those in Sweden 28.0±6.0 mg/day.

Conclusions: The maintenance doses of hydrocortisone observed in this study are in line with international guidelines in all four countries. The country difference in maintenance doses in DRHC is consistent with data showing that mean daily doses of hydrocortisone tend to be higher in Sweden than in other countries.