ECE2008 Poster Presentations Adrenal (61 abstracts)
Metabolic and cardiovascular profile in adult patients with addison's disease under conventional glucocorticoid replacement therapy
Roberta Giordano 1 , Alberto Falorni 2 , Marcella Balbo 3 , Stefania Marzotti 2 , Serena Romagnoli 2 , Elisa Marinazzo 3 , Ezio Ghigo 3 & Emanuela Arvat 1
1Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, Italy; 2Department of Internal Medicine, University of Perugia, Perugia, Italy; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy.
Object: In Addison’s disease hydrocortisone or cortisone have so far been used at doses of 30–37.5 mg/day, respectively, though several studies showed that cortisol normal production is about 5.7 mg/m2 (20–25 mg/day of hydrocortisone or cortisone, respectively). Differently from secondary hypoadrenalism, scanty data exist in patients with Addison’s disease on role of conventional glucocorticoid replacement and metabolic and cardiovascular outcome. A recent observational study has reported increase mortality rate in Addison’s disease patients conventionally treated.
Design: In 37 Addison’s disease patients (11 M and 26 F; 20–71 years) under conventional glucocorticoid replacement therapy (37.5 mg cortisone/day), BMI, fasting glucose and insulin, OGTT, cholesterol and triglycerides (TG), 24 h blood pressure and intima-media thickness (IMT) by eco-doppler ultrasonography were measured and correlated with sex, age, disease’s duration, ACTH, PRA and DHEAS.
Results: Mean BMI was in the upper normal range, though higher than 25.0 kg/m2 in 16 patients. Mean fasting glucose, insulin, HOMA and glucose after OGTT were in the normal range. HOMA was higher than normal in 4 overweight patients and in 2 of them OGTT was diagnostic for IGT. According to ATP III classification, mean total cholesterol was in the desiderable range, none of the patients had HDL lower than 40 mg/dl, whereas LDL was higher than 160 mg/dl in 4 overweight patients; only the 2 IGT patients showed increased TG levels. In all patients 24 h blood pressure showed a normal profile with a preserved circadian variation and IMT was below 0.9 mm. No correlation was found between the above mentioned parameters. None of the patients showed a global CV risk above 5% at 10 years (according to ATP III).
Conclusion: This study suggests that, in Addison’s disease, neither conventional glucocorticoid replacement therapy nor the reduced DHEAS secretion are associated with metabolic impairment and/or increased cardiovascular risk.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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