Introduction: Adrenal Insufficiency (AI) is characterized by absolute or relative deficiency of glucocorticoids and adrenal androgen precursors. Patients with AI show an impaired quality of life, metabolic status, immune function and dysregulated circadian genes. Data on sexual function are scarce and often contradictory. The aims of the present study are to evaluate sexual dysfunction (SD) in women and men patients with AI and to investigate the effects of restoring a more physiological circadian rhythm of glucocorticoid administration on sexual function.
Methods: Outcome assessors blinded, randomized, multicenter, active comparator clinical trial. 89 AI patients and 25 adrenal-sufficient matched controls were enrolled in the DREAM trial. AI patients on established multiple times a day glucocorticoid therapy were randomly assigned to continue their therapy or to switch to an equivalent dose of once-daily, modified-release hydrocortisone. 63 patients (34 women and 29 males) consented and completed sexual function evaluation (FSFI, IIEF-5 and AddiQoL questionnaires and hormonal evaluation) at enrollment and study completion (24 weeks).
Results: Sexual dysfunction was found highly prevalent in men (30%) and pre-menopausal AI women (45%); in menopausal AI women it was even more frequent (85.7%), but similar to the general population. In AI women, sexual health positively correlated with duration of disease (P=0.008) and estrogenic status (P=0.007). The questionnaires domain for arousal negatively correlated with age. In pre-menopausal women there was no correlation with androgen levels, while sexual function positively correlated with the Symptom score of AddiQoL (P=0.022). In post-menopausal patients there was a positive correlation of sexual function with testosterone levels (P=0.008). In males, erectile dysfunction significantly correlated with quality of life (P=0.020), while there was no correlation with age, androgen levels and metabolic profile. At 24 weeks there was no detectable difference in sexual function between randomization groups (standard vs. switch).
Conclusions: Young patients with AI show an increased prevalence of sexual dysfunction. Sexual health correlated with estrogen levels and duration of disease in women and with QoL in men. Restoring a better circadian profile of glucocorticoid therapy was not effective in improving sexual function. The lack of correlation with androgens in males and pre-menopausal women suggest that sexual dysfunction in AI has a more complex multifactorial etiology.
18 - 21 May 2019
European Society of Endocrinology