Endocrine Abstracts

Context: Patients with adrenal insufficiency (AI) have excess mortality and morbidity, mainly due to cardiovascular diseases. The mechanisms for this is unclear.

Objective: To assess cardiovascular structure and function in AI patients on conventional replacement therapy and after switching to once-daily, modified-release hydrocortisone (OD-HC).

Methods: The analysis included 17 adult AI patients (11 with primary AI, 7 with secondary AI)on stable replacement with cortisone acetate [median (minimum, maximum) 33.5 (12.5–50) mg] and, if needed, fludrocortisone [0.1 (0.05–0.2) mg], and 17 healthy matched controls. Ten patients switched to an equivalent dose of OD-HC. Echocardiography, 24-hour Holter-ECG and 24-hour blood pressure monitoring were performed at baseline and 6 months after the switch to OD-HC.

Results: At baseline, AI patients had smaller left ventricular diastolic diameter (47.1 ± 4.2 vs 51.6 ± 2.3 mm; P = 0.001) and left atrial diameter (34.9 ± 4.7 vs 38.2 ± 2.6 cm; P = 0.018), and a higher ejection fraction (62.5 ± 6.9% vs 56.0 ± 4.7%; P = 0.003) than controls. AI patients had lower nocturnal systolic and diastolic blood pressure than controls (108.3 ± 14.7 mmHg vs 117.2 ± 8.3 mmHg; P = 0.038 and 65.1 ± 9.4 vs 72.9 ± 6.6 mmHg; P = 0.008, respectively). After the switch to OD-HC, nocturnal diastolic blood pressure normalised. No significant changes were observed in echocardiographic and Holter-ECG parameters following the switch.

Conclusions: AI patients on conventional treatment display cardiovascular abnormalities that could be related to hypovolemia. Switch to OD-HC seems to have beneficial effect on blood pressure profile, but no effect on cardiovascular structure and function.