Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2015) 37 EP1350 | DOI: 10.1530/endoabs.37.EP1350

ECE2015 Eposter Presentations Endocrine nursing (6 abstracts)

Continuous subcutaneous hydocortisone infusion replacement treatement in adrenal insufficiency – how to start the hydrocortisone infusion

Katerina Simunkova 1 , Nevena Jovanovic 2 , Espen Rostrup 1 , Paal Methlie 2 , Marianne Øksnes 1 , Roy Miodini Nilsen 4 , Hanne Hennø 1 , Mira Tilseth 1 , Kristin Godang 3 , Ana Kovac 1 , Kristian Lovas 1 & Eystein Sverre Husebye 1

1Departments of Clinical Science, University of Bergen, Bergen, Norway; 2Department of Medicine, Haukeland University Hospital, Bergen, Norway; 3Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway; 4Global Public Health and Primary Care University of Bergen, Bergen, Norway.

Many patients with primary adrenal insufficiency (Addison’s disease) take extra doses of glucocorticoids before or during stressful events, but benefit has not been demonstrated. We aimed to test the effect of an extra dose of glucocorticoids on cardiorespiratory, hormonal and metabolic parameters in response to physical activity in a randomised placebo-controlled, 2-weeks cross-over, clinical trial ( NTC01847690). Ten women with Addison’s disease and ten female controls participated in the study. All underwent maximal incremental exercise testing. A stress dose of 10 mg hydrocortisone or placebo was given 1 h before exercise on two occasions. Blood samples were drawn before, and at 0, 15 and 30 min post exercise. The glycaemia was followed by continuous glucose monitoring for 24 h. The primary endpoints were oxygen uptake (O2 uptake), maximal aerobic capacity (VO2 max). Secondary outcomes were detailed ergometric parameters, and duration of exercise, post-exercise hypoglycaemic events and glycaemic variability, endocrine and metabolic responses to physical activity, and health status evaluated by questionnaires. VO2max and duration of exercise were significantly lower in patients compared to controls and did not improve with the treatment. Stress-dosed hydrocortisone elevated serum cortisol significantly (cortisolmax mean 671 nmol/l (S.D. 49) vs 204 nmol/l (S.D. 41), P<0.0001). After exercise the blood glucose and adrenaline levels were significantly lower, and free fatty acids slightly higher, in the patients than in the controls, irrespective of stress dose. No differences were found between the treatments in metabolic or hormonal parameters or quality of life after the exercise. In conclusion, patients did not obtain benefits from stress-dosed hydrocortisone during strenuous short-term exercise. And such dosing does not seem justified in this setting.

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