Endocrine Abstracts

Introduction: In adults with Addison disease, over glucocorticoid replacement therapy is associated with an increased morbidity and decreased life expectancy, related to low bone mineral density and cardiometabolic outcomes. The aim of our study was to assess the prevalence of carbohydrate metabolism disorders in patients with Addison disease and identify its predictive factors.

Patients and methods: A cross sectional study including 50 patients diagnosed with Addison disease with a mean duration of glucocorticoid replacement of 13.9 years. Biochemical markers of glucose metabolism were evaluated.The prevalence of type 2 diabetes and its complications were analyzed. Patients presenting type 1 diabetes were excluded from our study.

Results: The mean age of patients was 49.5±13.9 years (18–78 years) with significant female predominance and a sex ratio of 0.25.High blood pressure (52%) and diabetes mellitus (52%) were the most common family histories. Mean fasting blood glucose at the diagnosis of Addison disease was 4.6±0.6 mmol/l (3.6–5.4 mmol/l). Mean glycated hemoglobin (HbA1c) was 4.6±0.7%(3.8–5.5%).No patient had prediabetes nor diabetes at the diagnosis. At the time of our study, disorder of carbohydrate metabolism was found in over a third of patients (38%) after a mean duration of Addison disease of 17.5±5.4 years (4–35 years).Among those patients, 31.6% had type 2 diabetes. Diabetic retinopathy occurred in 2 patients and one patient complained of diabetic neuropathy. Daily and cumulative dose were higher in patients with diabetes compared to those with normal blood sugar level (27,5±5 mg/day versus 25.6±6.9 mg/day; 506.2±277.2 mg versus 355.4±282.9 mg) without significant difference. As well, longer Addison disease duration was found in patients presenting diabetes compared to those with a normoglycemia (19.8±9.9 versus 13.2±8.4 years; P=0.1).

Conclusion: At the present time, despite of the worldwide availability of replacement therapy in Addison disease, exposure to supraphysiological dose of corticosteroids leads to altered insulin secretion and decreased hepatic and muscular insulin sensitivity, that result in risk exacerbation of carbohydrate metabolism disorders.