ECE2020 Audio ePoster Presentations Adrenal and Cardiovascular Endocrinology (121 abstracts)
1King’s College London - Waterloo Campus, London, United Kingdom; 2The London Clinic, London, United Kingdom; 3UK cortisol pump group, United Kingdom
Real life experience of 8 people with adrenal insufficiency using subcutaneous hydrocortisone infusion in continuous and pulsatile regimens recruited through hydrocortisone pump support group
Background: Subcutaneous hydrocortisone (HC) infusion using continuous (CSHI) and pulsatile (PSHI) regimes are treatment options for adrenal insufficiency. It is an off-labelled treatment in UK for patients with adrenal insufficiency (AI).
Both treatment aim to mimic natural body circadian rhythm of cortisol production. Continuous regimes deliver a consistent rate of hydrocortisone using an Insulin Pump, programmed to mimic a circadian rhythm. Pulsatile regimes use a pump developed specifically for hydrocortisone and aim to more closely replicating circadian rhythms by delivering extra hydrocortisone at mealtimes.
We surveyed 8 cohorts via Cortisol Pump UK support group in Facebook to capture their data in the following area:
Quality of Life AddiQoL scores
24 hours infusion doses & type of regimens
HC doses according to body surface area (BSA)
A&E, hospital admission before & after starting on HC pump
Improvement since started on HC pump
Challenges with HC pump.
Survey Monkey conducted in February 2019
Results: Mean age 47 (31–51); All female; Mean AddiQoL score 87.5/120 with 2 primary AI, 2 unknown, 4 secondary AI. 6 on continuous subcutaneous hydrocortisone infusion and 2 on pulsatile subcutaneous hydrocortisone infusion. Mean length of time on infusion 12 months (10 days - 22 months); mean body surface area dose per day 17.425 mg.
Conclusion: Those with daily dose between 20- 25mg has a higher mean AddiQoL score compare to those with a daily dose above 30mg ( 100/120 vs 80/120).
Mean daily rate per body surface area is higher than previous studies. A&E visits and hospital admissions in this cohort has reduced from 38 visits to 2 visits for the first 6 months or since started on pump.
Larger studies are needed to look of the effects of these 2 regimens.