Background: Patients with Addisons disease (AD) have increased morbidity and mortality. Cardiovascular disease is considered the leading cause of death. The aim was to study cardiovascular risk factors in patients with AD.
Methods: In a single-centre, caseontrol study 78 patients (52 women) with AD were compared to 78 controls, matched for gender, age, BMI, and smoking habits. Serum was collected in a fasting state for measurement of lipids and glucose metabolism, supine blood pressure measured and computed tomography used to assess abdominal subcutaneous and visceral fat. The IDF 2006 criteria were used for the classification of the metabolic syndrome (MS).
Results: Patients and controls were well matched with a mean age of 53 years and BMI of 25 kg/m2. The mean (S.D.) duration of AD was 17 years (12). The median (range) daily hydrocortisone and fludrocortisone doses were 30 mg (1050 mg) and 0.1 mg (00.2 mg) respectively. Sixteen patients (21%) with a mean age of 59.8 (10.5) years fulfilled the criteria for the MS compared to eight controls (10%, P=0.09) aged 69.7 (11.6) years.
Fifteen percent of the patients had diabetes mellitus (type 1, 6% and type 2, 9%) and 44% had hypothyroidism compared to 1 and 3% of the controls. More patients had pharmacological treatment for hypertension (22 vs 5%; P=0.002) and dyslipidemia (14 vs 1%; P=0.003).
The HOMA-index and the amount of abdominal subcutaneous and visceral fat mass were not different among the groups but triglyceride concentration was increased (P=0.014), LDL-cholesterol reduced (P=0.025) and HDL-cholesterol was increased (P=0.091) in the patients as compared with controls.
Conclusion: Patients with AD receiving standard replacement therapy have higher frequency of MS in a younger age and higher triglycerides compared to well matched controls. This may be explained by the relatively high hydrocortisone dose used for replacement. The control group which might contribute to the increased cardiovascular death previously suggested.
27 Apr - 01 May 2013
European Society of Endocrinology