ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P50

Metabolic and cardiovascular profile in adult patients with addison's disease under conventional glucocorticoid replacement therapy

Roberta Giordano1, Alberto Falorni2, Marcella Balbo3, Stefania Marzotti2, Serena Romagnoli2, Elisa Marinazzo3, Ezio Ghigo3 & Emanuela Arvat1

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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