Object: In Addisons disease hydrocortisone or cortisone have so far been used at doses of 3037.5 mg/day, respectively, though several studies showed that cortisol normal production is about 5.7 mg/m2 (2025 mg/day of hydrocortisone or cortisone, respectively). Differently from secondary hypoadrenalism, scanty data exist in patients with Addisons disease on role of conventional glucocorticoid replacement and metabolic and cardiovascular outcome. A recent observational study has reported increase mortality rate in Addisons disease patients conventionally treated.
Design: In 37 Addisons disease patients (11 M and 26 F; 2071 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, diseases 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 Addisons disease, neither conventional glucocorticoid replacement therapy nor the reduced DHEAS secretion are associated with metabolic impairment and/or increased cardiovascular risk.
03 - 07 May 2008
European Society of Endocrinology