Endocrine Abstracts

Introduction

Retrospective analyses suggest that patients with adrenal insufficiency (AI) have an increased risk for cardiovascular diseases which was mainly attributed to non-physiological cortisol profiles and/or supraphysiological replacement doses.

Material and methods

We analyzed the 24-hour blood pressure (BP) profiles in patients with primary (PAI) and secondary (SAI) AI. BP threshold criteria for hypertension and dipping status of the 2018 ESC/ESH guidelines were used (24-h: ≥ 130 and/or ≥ 80, daytime: ≥ 135 and/or ≥ 85, night-time: ≥ 120 and/or ≥ 70, non-dippers: nocturnal BP drop < 10%). Results were correlated with daily intake of gluco-/mineralocorticoids, serum electrolytes, plasma-renin-concentration (PAI), salivary cortisol (SC) profile (06:00/12:00/16:00/20:00/22:00), 24-hour urinary free cortisol, BMI, waist-to-hip ratio and comorbidities.

Results

Fifty-two patients (30 PAI/22 SAI, age 55 (21–88), 36 females) were included. Twenty-two patients (11 AI/11 SAI) received antihypertensive treatment. Mean 24-h BP values were 124 ± 14/76 ± 10 mmHg (daytime 127 ± 15/79 ± 11, night-time 116 ± 18/69 ± 11). Prevalence of hypertensive 24-h BP was 42% (12% in patients without known hypertension), without differences between AI and SAI. Night-time hypertension was more prevalent than daytime hypertension (50% vs 35% in the whole cohort, 20% vs 8% in patients without known hypertension). Twenty-eight patients (14 AI/14 PAI) were classified as non-dippers. 20:00- and 22:00-SC levels were higher in patients with hypertensive compared to patients with normal 24-h BP (0.062 vs 0.02 P = 0.01, 0.054 vs 0.016 P = 0.004) regardless of antihypertensive treatment. Daily glucocorticoid intake was higher in patients with hypertensive 24-h BP (22.5(10–60) vs 20(15–30) mg P = 0.035).

Conclusion

Ambulatory hypertension and non-dipping were frequent in this small cohort of patients with AI and showed an association with supraphysiological glucocorticoid doses and exposure to glucocorticoids in the late afternoon/evening. However, validation in larger cohorts is warranted.