Endocrine Abstracts

Introduction: Long-term glucocorticoid replacement therapy in patients with Addison disease has been linked to an increased cardiovascular risk and consequent mortality. Our objective was to determine the frequency of dyslipidemia in patients with Addison disease and its potential predictive factors.

Patients and methods: This was a cross-sectional study, performed in the department of endocrinology in Hedi Chaker hospital –Sfax –Tunisia. Fifty patients with Addison disease were recruited between March 2020 and July 2021.Lipid profile at time of disease diagnosis and after glucocorticoid replacement was analyzed.

Results: The mean age of our patients was 49.5±13.9 years (18–78 years).The female sex was the most affected with a sex ratio of 4. The disease duration was 13.9±8.7 years on average with extremes between 5 and 35 years. Lipid profile at time of Addison disease diagnosis was normal in 81.5% of patients. For those presenting disturbed lipid balance, there were isolated hypercholesterolemia in two patients, hypertriglyceridemia in one patient and mixed dyslipidemia in 2 patients. At the time of our study, the prevalence of hyperlipidemia was 16% (8 patients), occurring after a mean duration of glucocorticoid replacement therapy of 13.6 years. The alterations in the lipid balance observed were mixed dyslipidemia in 5 patients, isolated hypercholesterolemia in one patient, hypertriglyceridemia in 2 patients and low HDL-cholesterol level in 5 patients. Among those patients, five patients were treated with statins and 2 patients with fibrates. One patient was on healthy diet. All lipid parameters increased at the time of the study compared to lipid profile at time of disease diagnosis: Total cholesterol level:4.3±0.9 mmol/l vs 3.7±1 mmol/l;Triglyceride level: 1.6±1 mmol/l vs 1.2±0.7 mmol/l;HDL-cholesterol level:1.4±0.3 mmol/l vs 1.1±0.5 mmol/l;LDL-cholesterol level:2.4±0.6 vs 2±0.6 mmol/l. There were no significant correlation between hyperlipidemia and cumulative hydrocortisone dose nor duration of glucocorticoid replacement therapy.

Conclusion: Our findings highlight the importance of controlling lipid status in patients with Addison disease. Identifing patients at risk of lipid metabolism disorders at the preclinical phase seems imperative to reduce cardiovascular complications of long-term glucocorticoid replacement therapy.