Endocrine Abstracts

The aim of this retrospective study was to compare the long-term metabolic evolution of a cohort of patients treated for adrenal insufficiency (AI), and the best biological parameters of a good balance.

Seventy patients with AI (mean age 41 years (±16); 60% female) were followed during a median 6-year period (2–16 years): 38 after bilateral adrenalectomy (60% Cushing) and 32 after AI of medical origin (62% polyglandular autoimmune syndrome). BMI, blood pressure (BP), fasting blood glucose (FBG), cholesterol, triglycerides, ionogram, plasma renin activity, ACTH before and 2 h after hydrocortisone intake, daily hydro- and fludro-cortisone were recorded at the beginning of replacement therapy (T1) and at last news (T2).

At T2 vs T1, the prevalence of overweight was 35% vs 17% (P<0.02), obesity 18% vs 22% (non significant; NS), hypertension 29% vs 31% (NS), dyslipidemia 26% vs 17% (P=0.058) and type 2 diabetes (T2D) 21% vs 8. Between T1 and T2, IMC (P<0.02) and FBG (P<0.0001) medians increased.

PRA levels were inversely correlated with T1 (p1=0.002) and T2 (p2=0.0001) natremia and positively correlated with kalemia (p1=0.07; p2=0.04) without any relation with fludrocortisone dose or BP. In contrast, fludrocortisone doses were positively correlated with T2 systolic BP (P=0.03) with a trend for natremia (P=0.08). T1 ACTH levels were significantly correlated with natremia (P=0.004). ACTH levels 2 h after hydrocortisone intake were not influenced by hydrocortisone doses. In contrast, hydrocortisone doses were correlated with diastolic BP (p1=0.02; p2=0.006), T2 FBG (P=0.03), with a trend for BMI (p1=0.09; p2=0.07). Hydrocortisone doses/kg of body weight were higher in case of T2D (P<0.03).

Conclusion: weight and T2D increased significantly during the follow-up, in relation with hydrocortisone dose. Both hydro and fludrocortisone doses control BP. Hormonal measurements (PRA, ACTH…) do not bring more than BP and ionogram to the quality of replacement therapy.