Endocrine Abstracts

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.