Endocrine Abstracts

Dehydroepiandrosterone (DHEA) has been a subject of controversy for more than a decade being called ‘a miracle hormone’, the ‘elixir of life’ and ‘an anti-aging supplement’. However, recent literature has proven mild to moderate benefit in selected group of patients. Data is mostly limited to primary adrenal failure patients with adequate glucocorticoid and mineralocorticoid replacement and in hypopituitarism from variable aetiology associated with severe disabling quality of life. We present here a small study of four patients with prolonged hypothalamic-pituitary-adrenal (HPA) axis suppression from high dose glucocorticoids who were prescribed DHEA. All 4 patients had been diagnosed with adrenal insufficiency following long-term steroid use for a variety of conditions; Asthma, Polymyalgia Rheumatica and Allergic Bronchopulmonary Aspergillosis. The age range of our patients was 45 to 70 years on commencement of DHEA with a mean age of 62.5 years. Despite adequate steroid replacement as evidenced by Cortisol day curves, our patients continued to suffer from poor quality of life with symptoms of extreme lethargy, nausea, dizziness, muscle aches and reduced productivity. Longer acting steroid preparation in the form of Plenadren was tried in one of the patients with little benefit. All 4 patients had Dehydroepiandrosterone Sulphate (DHEA-S) levels which were undetectable at <0.4 μmol/l (0.9–11.6 μmol/l) prior to commencement of DHEA. Considering significant impact on quality of life, DHEA was trialled in doses 25 mg to 50 mg. AddiQoL-30 questionnaire (a validated assessment tool used to assess the impact on quality of life in patients with Addison’s disease) was used pre and post treatment to assess efficacy of treatment. All patients showed significant improvement in quality of life scores ranging from 13 to 42 points, with a significant mean improvement of 23 points. Our study has explored benefits in a relatively new cohort of patients with prolonged HPA axis suppression from glucocorticoid use. Widespread use of high dose steroids have increased such presentations to Endocrine clinics and hence, we highlight the need for further large group randomized controlled trials including these subgroups for future studies. The limitations of this study are the small number of cases without a control group however, this will be addressed in the future from our large cohort of selected patients with HPA axis suppression due to exogenous steroids.