Introduction: Primary adrenal insufficiency (PAI) can be of autoimmune origin (AI), non-autoimmune origin (bilateral adrenalectomy, acute hemorrhage, infection) (NAI) or pharmaceutical (mitotane) origin. Studies have shown that these patients develop long-term morbidities and increased mortality due to excessive glucocorticoid tissue exposure. Data about differences concerning hydrocortisone (HC) needs, cortisol hormonal levels and metabolic parameters in these patients are scarce.
Methods: This retrospective analysis included patients with PAI with follow-up more than 5 years (mean follow-up: 9±6.9 years). Patients had two different day curves of cortisol (F) measurements and 24 h urinary cortisol levels (UFC) and were on oral HC replacement treatment (total mg/day).
Results: We included 12 patients with Addison disease (AD), 8 patients under therapeutic mitotane levels (>13 mg/l) and six patients with PAI of other causes (NAI). BMI increases in all groups in the follow up and it is positively correlated with daily HC substitution (P=0.017, r=0.5). Mitotane group had statistical significant higher BMI at diagnosis compared to the two other groups (P=0.015). This difference among groups in the BMI disappears in the follow-up thus probably due to Cushing effect. NAI group had higher HC substitution compared to AD group (P=0.01) and higher Hb1Ac and cholesterol levels during follow up compared to AD group (P=0.02) and mitotane group (P=0.05). As expected HC substitution as well as UFC levels were significant higher in the mitotane group compared to the two other groups (P=0.0014, P=0.05 respectively). Median F levels were positively correlated with HC substitution (P=0.027) (mitotane group was excluded).
Conclusion: Patients with NAI had statistically higher HC substitution as well as Hb1Ac and cholesterol levels in the follow up compared to AD group. Despite the small sample of patients the over-substitution of these patients should be reconsidered regarding the consequences.
20 - 23 May 2017
European Society of Endocrinology