Endocrine Abstracts

Introduction: The treatment of adrenal insufficiency (AI) is based on long-term glucocorticoid substitution. Hydrocortisone (HC) is the most commonly used substitution molecule. The aim of our work was to determine the long-term bone impact of patients with peripheral AI.

Patients and methods: This is a descriptive and analytical study involving 77 patients with peripheral IS (66 women and 11 men), all treated with HC. For each patient, we determined the duration of the disease and the daily and cumulative dose of HC, and performed a phosphocalcic assessment, an alkaline phosphatase (ALP) determination, and a bone densitometry (BMD) performed in 30 patients.

Results: The mean age was 40.5 years (range: 22–63 years). The mean duration of evolution was 7.7 years. We found that among the patients who had a BMD, 75% had bone demineralization at the time of the study, which was more marked in the cancellous bone (spinous site). This prevalence was high compared to the Tunisian adult population (75% vs 45.7%). This demineralization was positively correlated with the cumulative dose of HC (mean cumulative dose (g) =60±80.4 in patients with normal BMD vs 132±86.4 in patients with bone demineralization; P=0.042), and was more frequent but not significantly so in postmenopausal women. However, we did not find any correlation between bone demineralization and daily HC dose and disease duration, respectively. Biologically, at the time of the study, ALP was elevated and hypocalcemia was present in 15% and 26.7% of patients, respectively. However, we did not find any correlation between these two biological abnormalities and the daily dose of HC, the cumulative dose and the duration of the disease respectively.

Conclusion: Hormone replacement therapy of peripheral AI with HC seems to be a risk factor for bone demineralization, especially with the higher cumulative dose of this corticoid. Further studies are needed to better define the cumulative dose threshold at which bone densitometry monitoring is indicated.