Endocrine Abstracts (2015) 37 EP39 | DOI: 10.1530/endoabs.37.EP39

Clinical management of adrenal insufficiency shows significant heterogeneity: data from the EU-AIR study

Robert D Murray1, Bertil Ekman2, Beverly A Jones3, Claudio Marelli4, Marcus Quinkler5 & Pierre Zelissen6


1Leeds Teaching Hospitals NHS Trust, Leeds, UK; 2Linköping University, Linköping, Sweden; 3Shire PLC, Chesterbrook, Pennsylvania, USA; 4Shire International GmbH, Zug, Switzerland; 5Endokrinologie in Charlottenburg, Berlin, Germany; 6University Medical Center Utrecht, Utrecht, The Netherlands.


Introduction: No consensus guidelines currently exist as to the optimal glucocorticoid regimen in adrenal insufficiency (AI). In clinical practice physicians utilise a number of different glucocorticoids, usually administered in several doses throughout the day.

Methods: The EU-AIR registry is a European multinational, multicentre, prospective, observational study sponsored by Shire inclusive of all patients with AI irrespective of aetiology. We analysed the baseline data of patients with primary (PAI) and secondary AI (SAI), excluding patients with CAH, to gain insight into AI current clinical management.

Results: As of 5th November 2014, 946 patients with AI (54.6±16.4 years, 510 (53.9%) F, BMI 28.0±5.5 kg/m2, 310 (32.8%) PAI) were enrolled in to the study. Overall 91.8% of patients were receiving hydrocortisone (HC) as preferred glucocorticoid replacement, 6.8% prednisolone, 1.6% cortisone acetate, and 0.1% dexamethasone. For patients receiving HC, daily doses ranged from 5 to >45 mg. Most patients received 20–<25 mg (44.9%), with 24.3 and 16.0% receiving 15–<20 and 25–<30 mg respectively. 15.0% of patients were receiving HC doses ≥30 mg. Patients with PAI and SAI were receiving average HC doses of 23.3 and 19.3 mg respectively. HC was taken OD, BID, TID, and QID in 6.7, 52.1, 43.9, and 1.8% respectively. Patients with PAI were more likely to be receiving HC TID compared with those with SAI (56.9% vs 37.6%), who received their HC most frequently as a BID dosage (42.0% vs 56.9%). For patients receiving prednisolone daily doses ranged from <2 to >7.5 mg, with the majority (65.6%) receiving 5–<6 mg/day. A daily dose ≥6 mg was taken by 21.8%. Prednisolone was taken OD, BID, and TID in 73.4, 29.7, and 1.6% respectively.

Conclusions: We have demonstrated significant heterogeneity in the current management of AI in type of glucocorticoid, dosage, and frequency of administration. This likely reflects individualisation of regimes in the absence of robust data supportive of the optimal regimen for long-term outcomes.

Disclosure: This work was supported by Shire International GmbH.

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