Background and objective: Optimization of glucocorticoid (GC) replacement therapy in adrenal insufficiency (AI) is crucial to avoid consequences of under- or overtreatment. Dosing of GC replacement is mainly based on clinical grounds; however, the impact of patients characteristics on daily GC requirement is poorly evaluated. The aim of the study is to assess the influence of sex (M/F) and BMI on dosing GC in patients with AI of different etiology.
Patients and methods: We retrospectively analysed 203 patients (104 primary AI [pAI], and 99 secondary AI [sAI]) followed-up for >12 months over the last 2 decades treated with hydrocortisone (HC), HC modified release (HCMR) or cortisone acetate (CA). We evaluated the total daily dose (TDD) and per-Kg-daily dose (KDD) of GC either at baseline or at the last visit. We considered comorbidities (arterial hypertension, diabetes mellitus and dyslipidemia) at each time point.
Results: At baseline, we did not observe any difference in clinical characteristics and comorbidities between F and M patients with pAI (65 F, 39 M). KDD was higher in F than in M (F, 0.47±0.19 vs M, 0.38±0.47 mg/kg per day, P=0.016). At last visit, BMI was stable in F, but KDD and TDD were significant lower than at baseline (0.47±0.19 vs 0.38±0.14 mg/kg per day, P=0.014 and 25.77±8.02 vs 23.24±6.33 mg/day, P=0.048, respectively). In M with pAI, BMI, KDD and TDD were not different between baseline and last visit. Therefore, KDD and TDD were not significant different between genders at last visit. In patients with sAI (53 F, 46 M) both at baseline and at last visit, KDD was not significant different between genders. Conversely, TDD at last visit was significantly lower in F than in M (F 18.40±6.95 vs M 23.37±8.14 mg/day, P=0.001). Comorbidities were comparable between groups. At baseline, the use of hydrocortisone was preferred in pAI, while the use of CA was more frequent in sAI. At last visit, the rate of patients in HCMR was higher in pAI than in sAI. BMI was higher in sAI than in pAI, as well as TDD and KDD.
Conclusions: Our real life study demonstrates that in pAI GC replacement is likely overdosed in F when treatment is initiated. Optimization of replacement and a more extensive use of HCMR lead to a marked GC dose reduction in F patients with pAI during follow-up. In sAI patients, lower GC starting doses are used with minimal dose adjustment during follow-up.
18 - 21 May 2019
European Society of Endocrinology