Endocrine Abstracts

Introduction

Adrenal insufficiency is a clinical condition that leads to depletion of glucocorticoids, mineralocorticoids and androgens. While in men adrenal androgen deficiency is not clinically significant for testicular testosterone synthesis, in women so far androgen treatment is suggested for the reduction of libido and depression. However, no data is currently available on female sexual function.

Primary endpoints

1) To study the prevalence of Female Sexual Dysfunction (FSD) in women with adrenal insufficiency; 2) To compare the obtained data with a healthy control group.

Secondary endpoints

1) To evaluate the correlation between FSD and sexual distress in patients with adrenal insufficiency; 2) To study the impact of different glycoactive-therapies on sexuality; 3) To evaluate the correlation between FSFI-6 total scores and cortisol and ACTH levels.

Patients and methods

22 women with adrenal insufficiency and 23 healthy women were recruited as controls. A clinical investigation was carried out, including anamnesis, physical examination, serum cortisol and ACTH dosage. In addition, Female Sexual Function Index-6 (FSFI-6) and Sexual Distress Scale (SDS) questionnaires were administered to the patients.

Results

The prevalence of FSD (total score < 19) was significantly higher in women with adrenal insufficiency (15/22; 68.2%) compared to controls (2/23; 8.7%; P = 0.001). Regarding the questionnaire items, a significantly different score was found for desire (P < 0.001), arousal (P = 0.0006), lubrication (P = 0.046) and overall sexual satisfaction (P < 0.0001) in women with adrenal insufficiency compared to controls. A significant inverse correlation was found between FSFI-6 total scores and sex-related distress (r = –0.65; P = 0.0011), a significant direct correlation was found between FSFI-6 total scores and cortisol plasma levels (r = 0.55; P = 0.035). No statistically significant differences for any of the FSFI-6 items or total score was found between women treated by hydrocortisone or cortisone acetate and women treated by a modified release hydrocortisone formulation. No statistically significant correlations were found between ACTH plasma levels and total score for the FSFI-6 questionnaire.

Conclusions

A higher prevalence of FSD was found in women affected by adrenal insufficiency compared to the group of healthy women. Desire seems to be the most impaired part of sexual response. Moreover, sexual dysfunction in this population seems to be related to sexual distress and cortisol serum levels. Further studies on larger series are needed to confirm these data on this sensitive issue.