Endocrine Abstracts

Background: In contrast to patients of European origin, primary adrenal insufficiency (PAI) in Indians is more common in males and often results from infectious etiologies (tuberculosis, Histoplasmosis). Most patients are treated with prednisolone, rather than hydrocortisone (HCT). A poor quality of life (QOL) has been reported in European patients with AD, but not in other populations. A few studies have also reported a high frequency of hypogonadism in PAI.

Objectives: To study the QOL and frequency of hypogonadism in Indian male patients with PAI.

Methods: In a cross sectional study, we recruited 37 male patients with PAI (age median (range) 53 (26–64) years; duration of illness 5.8 (1.4–28) years; 95% on prednisolone; 57% with infectious etiology). All patients were administered the short form SF36v2 questionnaire, previously validated in Hindi, to assess their QOL. A questionnaire regarding more specific symptoms of hypogonadism was also administered. An early morning serum total testosterone (T) was collected; in patients with low T (<10.4 nmol/l), the test was was repeated. Age, sex and, body mass index matched healthy controls (n=76) were studied.

Results: When compared with controls, patients had a highly significant reduction in QOL in each individual domain of SF36v2 (P<0.001), and in the summary physical (P<0.001) and mental component (P<0.04) domains. Twenty five (65%) patients had at least 1 symptom, while 17 (46%) had ≥3 symptoms suggestive of hypogonadism. However, only 5 (13.5%) patients had T<10.4 nmol/l. On multivariate analysis, the average daily glucocorticoid dose (hydrocortisone equivalent/m²) was strongly associated with decreased QOL across most domains, while T2DM and increasing age were associated with poor QOL in a few domains. However, serum testosterone did not predict QOL.

Conclusion: A poor QOL was noted in all domains in male patients with primary adrenal insufficiency. A higher daily glucocorticoid dose was independently associated with poor QOL in most domains. While symptoms of hypogonadism were frequent, the frequency of decreased serum testosterone was low.