Introduction: The reason for weight gain is multifactorial. Effective intervention can only be incorporated if the underlying cause is evaluated correctly. Here we present a lady with Addisons disease who gain significant weight and was helped to lose weight using a novel approach.
Case-Report: 42 year-old lady was referred to our weight-management service as she was unsuccessful in losing weight. Detailed evaluation in the obesity clinic revealed that she had poorly controlled Addisons disease for 4 years. She complained of excessive tiredness, hair loss, nausea, vomiting and several unexplained collapses. Following each collapse, she increased her steroid dose. At time of first visit, she was taking on an average Hydrocortisone (HC), 100 mg a day. As a result, she had gained 26 kg in 6 months. On clinical examination, her weight was 93.8 kg with BMI of 38.01 kg/m2. She had no abnormal pigmentation and there was no postural drop of blood pressure. She was not cushingoid. Resting ECG, 7-day event recorder, EEG and urinary catecholamines were all within normal limits. In view of recurrent collapses and the fact she was feeling better with injectable HC she was taking during her collapses, we commenced her on continuous subcutaneous hydrocortisone infusion via pump. The dose and rate of HC infusion was adjusted according to hydrocortisone day curve and she is now on HC 20.8 mg/day. She has lost 25 kg since she has been on HC pump. She no longer experiences any collapses and her quality of life has significantly improved.
Discussion: Over-replacement of hydrocortisone in patients with adrenal insufficiency can result in significant weight gain. Continuous subcutaneous hydrocortisone injection via pump allows clinician to mimic near physiological cortisol levels. It also helps to overcome problems with malabsorption if any. People with Addisons disease are not active due to tiredness. This mode of delivery of HC ensures adequate replacement and increases their confidence and activity levels.
Conclusion: Hydrocortisone pump could be considered in a patient with poorly controlled Addisons disease requiring large doses of HC. The pump not only delivers appropriate HC but also prevents weight gain.