Endocrine Abstracts

Introduction: Retrospective analyses suggest an increased risk for cardiovascular diseases in patients with adrenal insufficiency (AI), mainly due to supraphysiological replacement doses.

Objective: To evaluate the 24-hour blood pressure (BP) profile in patients with primary (PAI) and secondary (SAI) AI.

Material and methods: 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 hormone replacement therapy, 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 correlated with higher glucocorticoid doses and exposure to glucocorticoids in the late afternoon/evening. However, validation in larger cohorts is warranted.