Endocrine Abstracts

Objective: To investigate a selection of novel bone or immunomarkers which may act as indicators for steroid replacement in Adrenal Insufficiency (AI).

Introduction: AI is a condition where individuals are not able to produce sufficient steroids for their body’s requirement. Although mortality rates have improved since the introduction of exogenous steroid replacement, this condition is still associated with increased mortality and morbidity. This could be attributed to either over- or under-replacing patients with exogenous steroids. The absence of an objective marker makes steroid replacement a challenge. It has been shown that excess glucocorticoids lead to increased bone loss as well as immune suppression.

Methods: This is a pilot cross-sectional study looking at 22 participants who were split into four groups based on the dose of exogenous steroid administered (high-dose steroids, replacement dose hydrocortisone, replacement dose prednisolone and healthy controls). Blood samples and anthropometric data were collected from participants. Carboxylated-Osteocalcin (Gla-OC) and bone-related immunological cytokines were investigated.

Results: The high-dose steroid group had a significantly higher Gla-OC vs control (9.78 ng/ml vs 4.70 ng/ml, P=0.034) and vs the prednisolone group (9.78 ng/ml vs 3.78 ng/ml, P=0.032). IL-4 was significantly higher between the high-dose steroid and hydrocortisone group (22.6 ng/ml vs 3.52 ng/ml, P=0.033) and between the control and hydrocortisone group (21.0 ng/ml vs 3.52 ng/ml, P=0.032).

Conclusion: This study has demonstrated that Gla-OC and IL-4 show significant detectable changes between healthy controls, steroid replacement regimens and anti-inflammatory steroid regimens. They display potential to be long-term markers of steroid replacement and a larger prospective study to evaluate these markers further, is warranted.