Endocrine Abstracts

Introduction: During adrenal insufficiency (AI), glucocorticoid treatment is supposed to be neutral on the metabolic parameters of patients. However, recent data from the literature report that this corticosteroid replacement therapy increases the metabolic risk. The aim of our work was to determine the metabolic and cardiovascular impact of hydrocortisone (HC) replacement therapy during peripheral AI.

Patients and methods: This was a descriptive and analytical study involving 77 patients with peripheral AI (66 women and 11 men), all treated with HC. For each patient, we determined the length of the disease, the duration of the follow-up, the daily and cumulative dose of HC, the evolution of metabolic parameters (weight, blood pressure, glycemia, lipid parameters), and the Framingham score under HC.

Results: The mean age was 40.5 years (range: 22-63 years). The mean duration of evolution was 7.7 years. The study of metabolic and cardiovascular parameters after treatment with hydrocortisone showed weight gain in 96.1% of patients (overweight: 46.75% and obese: 40.25%). We noted that 41.5% of patients had developed hypertension, 54.54% had pre-diabetes, 37.66% had diabetes mellitus, 52% had dyslipidemia. We noted a significant positive relationship between daily HC dose and the development of obesity (P <10⁻⁴), hypertension (P: 0.003), diabetes mellitus (PP: 0.025) and dyslipidemia (P: 0.004), respectively. We found a significantly positive relationship between, on the one hand, disease duration, cumulative HC dose and, on the other hand, obesity (P:0.05/P:0.029), hypertension (P<10⁻⁴/P<10⁻⁴), and glycemic homeostasis disorders (P: 0.03/P: 0.02), respectively. For cardiovascular risk, we noted an elevation of the Framingham score after HC treatment (>20% in 6 patients), with a positive correlation between this score and, respectively, disease duration (P: 0.036), cumulative HC dose (P: 0.022), female sex (P: 0.001) and menopause (P: 0.044). In the same setting, four patients had experienced a cardiovascular event, and were all on a HC dose ≧30 mg/d.

Conclusion: The metabolic and cardiovascular risk of corticosteroid replacement therapy with HC during AI appears to be real. It increases with the duration of the disease and the cumulative dose of HC. Regular monitoring of metabolic and cardiovascular parameters is therefore essential with constant re-evaluation of the dose of this drug in these patients.