Endocrine Abstracts

Introduction: Hydrocortisone (HC) is the most widely used replacement molecule in the treatment of adrenal insufficiency (AI). This substitution treatment is far from ideal especially as it is impossible to reproduce the nycthemeral cycle of cortisol with its current galenic form which has a short half-life. The aim of our work was to determine the impact of HC treatment of peripheral AI on the long-term quality of life and sleep.

Patients and methods: This is 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 duration of the disease, the daily and cumulative dose of HC, the number of times HC was taken, the SF-36 quality of life score and the Pittsburgh sleep quality score in 58 patients.

Results: The mean age was 40.5 years (range: 22–63 years). The mean duration of progression was 7.7 years. We found that the percentage of patients with impaired quality of life was higher than in the healthy Tunisian adult population (79.31% vs. 51%), with a lower mean SF-36 global score (54.9 vs. 69.4). We noted a better quality of life in case of three HC intakes compared to two (P: 0.006). Regarding sleep quality, we found that 24% of patients had a sleep disorder of the type insomnia of the second part of the night with early awakening, without any correlation with the HC dose. This prevalence was higher than in the general adult population (24% vs. 9.7%). This quality of sleep seems to be better in case of three intakes of HC (morning, noon and afternoon).

Conclusion: Our results agree with those of the literature, since it appears that a 3-dose schedule was more beneficial for quality of life and long-term sleep. However, even with these HC dosing regimens, we remain far from the physiological rhythm of cortisol, and new modified-release HC preparations (DuoCort/Chronocort) could allow to better mimic the nycthemeral cycle of cortisol in patients suffering from AI.