Endocrine Abstracts

Patients with adrenal insufficiency show higher mortality than in the general population, mainly due to non-physiological daily glucocorticoid overexposure and to inadequate cortisol exposure during stress-related events and illness. The aim of the current study is to compare the impact of 10 years of conventional glucocorticoid (GC) replacement treatment and dual-release hydrocortisone (DR-HC), on anthropometric, metabolic, cardiovascular and bone outcomes in treatment-naïve patients with primary adrenal insufficiency (PAI) and secondary adrenal insufficiency (SAI). Forty patients (19 with PAI and 21 with SAI) were randomly allocated to conventional GCs (cortisone acetate or hydrocortisone) administered two or three times a day and 43 (20 with PAI and 23 with SAI) on dual-release hydrocortisone (DR-HC). Anthropometric, metabolic, cardiovascular and bone parameters were evaluated at baseline and after 5 and 10 years of follow-up. All patients enrolled completed the study. Among patients with PAI, one patient developed hypothyroidism after 2 years from the diagnosis of adrenal insufficiency and another patient developed type 1 diabetes mellitus after 1 year from diagnosis of adrenal insufficiency. Patients with SAI mainly had stable control for other pituitary insufficiencies during 10 years of treatment. In patients treated with conventional GCs, a trend of significant increase in BMI (P=0.040), waist circumference (WC) (P=0.001), systolic and diastolic blood pressure (P=0.017 and P=0.035), HOMA-IR (P=0.035), area under curve-2 hours (AUC_2h) of insulin and glucose (P=0.018 and P=0.003), and a trend of significant decrease in oral disposition index (DIo) (P=0.025) and Isi-Matsuda (P=0.043) were observed at 5 and 10 years of follow-up. In patients treated with DR-HC, a trend of significant decrease in triglycerides and LDL cholesterol (P=0.034 and P=0.032, respectively) was observed after 5 and 10 years of follow-up compared to baseline. At 10 years of follow-up, patients with conventional GCs had significantly higher values of BMI (P=0.031), WC (P=0.047), systolic blood pressure (P=0.039), total and LDL cholesterol (P=0.041 and P=0.042), HbA1c (P=0.040), HOMA-IR (P=0.006), AUC_2h of glucose (P <0.001), thickness of the interventricular septum in diastole and of the posterior wall (both P <0.001) and significantly lower values of DIo (P=0.001) and ISI-Matsuda (P <0.001), lumbar spine T score (P=0.036) and femoral neck Z score (P=0.026), compared to patients treated with DR-HC. In patients with treatment-naïve AI, 10 years of therapy with conventional GCs was associated with a worsening of metabolic, cardiac and bone outcomes, while DR-HC had no impact on them achieving a lower risk of developing comorbidities.