ECE2015 Guided Posters Adrenal (8 abstracts)
Effect of the switch from conventional glucocorticoids to ‘dual release hydrocortisone' in adult patients with primary and secondary adrenal insufficiency: a 6-month multicentre study
Rosario Pivonello 1 , Chiara Simeoli 1 , Andrea M Isidori 2 , Alessandro Ciresi 3 , Silvia Savastano 1 , Renata S Auriemma 1 , Chiara Graziadio 2 , Carolina Di Somma 1 , Carla Giordano 3 , Andrea Lenzi 2 & Annamaria Colao 1
1Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Federico II University, Naples, Italy; 2Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; 3Section of Endocrinology and Metabolic Disease, DIBIMIS, University of Palermo, Palermo, Italy.
Adrenal insufficiency (AI) requires life-long glucocorticoid (GC) treatment, which is associated with an increased risk of metabolic syndrome (MS), probably due to cortisol overexposure for multiple drug daily doses, together with an impairment of quality of life (QoL). Moreover treatment compliance (TC) is reported to be suboptimal in AI patients. The current study aimed at investigating the impact of the switch from twice/thrice daily conventional GCs to once daily dual-release-hydrocortisone (DR-HC) treatment on metabolic profile, QoL and TC in patients with primary AI (PAI) and secondary AI (SAI). Thirty-five patients (12 with PAI (7F, 5M, 33–60 years), eight treated with cortisone acetate (37.5–75 mg/day) and four with HC (20–30 mg/day)) and 23 patients with SAI (9F, 14M, 20–77 years), 15 treated with cortisone acetate (18.75–37.5 mg/day) and eight with HC (15–20 mg/day) entered the study and were evaluated before and 6 months after the switch to DR-HC (PAI: 20–60 mg/day and SAI: 20–40 mg/day). At 6-month-follow-up, in PAI patients, body weight (BW) (P=0.036) significantly improved and a trend to a significant improvement was also found for waist circumference (WC) (P=0.086). A diagnosis of MS, performed in two patients (17%) at baseline, was not confirmed after 6 months. In SAI patients, BW (P=0.001), BMI (P=0.003), and WC (P=0.007) significantly improved. A clear diagnosis of MS, performed in seven patients (30%) at baseline, was confirmed only in 4 (17%) of these patients after 6 months. In a subgroup of 12 patients with AI, visceral adiposity index (VAI), an indicator of adipose function and distribution, which seems to indirectly express the cardiometabolic risk, significantly improved (P=0.05) while an improvement in glucose levels (P=0.064) and in insulin sensitivity index (ISI 120) (P=0.052) was reported 120 min after glucose load. In the subgroup of ten patients considered for the evaluation of QoL and TC, working ability ameliorated in six patients (60%), vitality in 5 (50%), general health perception and depression in three patients (30%) and body pain perception in 2 (20%) patients. Moreover, 9 (90%) of these ten patients improved TC, changing from low to medium adherence. In conclusion, the switch from conventional GCs to DR-HC in patients with AI improved BW, BMI, WC, prevalence of MS, glucose tolerance and insulin sensitivity, QoL and TC.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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