ECE2022 Poster Presentations Adrenal and Cardiovascular Endocrinology (87 abstracts)
Impact of glucocorticoid-induced adrenal insufficiency on health-related quality of life
Stina Willemoes Borresen 1 , Victor Brun Boesen 2 , Torquil Watt 2,3 , Jakob Bue Bjorner 4,5,6 , Bo Baslund 7 , Henning Locht 8 , Toke Bjørk Thorgrimsen 8 , Bente Jensen 8 , Søren Schwartz Sørensen 9,10 , Merete Lund Hetland 10,11 , Annette Hansen 12 , Jesper Nørregaard 13 , Marianne Klose 1 & Ulla Feldt-Rasmussen 1,10
1Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, Department of Medical Endocrinology and Metabolism; 2Copenhagen University Hospital, Herlev-Gentofte, Herlev, Denmark, Department of Internal Medicine; 3Institute of Clinical Medicine, University of Copenhagen; 4QualityMetric, USA; 5National Research Centre for the Working Environment, Copenhagen, Denmark; 6University of Copenhagen, Copenhagen, Denmark, Department of Public Health; 7Copenhagen University Hospital, Rigshospitalet Blegdamsvej, Copenhagen, Denmark, Center of Rheumatology and Joint Diseases; 8Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark, Center of Rheumatology and Joint Diseases; 9Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, Department of Nephrology; 10Institute of Clinical Medicine, University of Copenhagen, Denmark; 11Copenhagen University Hospital, Rigshospitalet Glostrup, Denmark, Center of Rheumatology and Joint Diseases; 12Copenhagen University Hospital, Herlev-Gentofte, Denmark, Center of Rheumatology and Joint Diseases; 13Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark, Center of Rheumatology and Joint Diseases
Objective: Glucocorticoid-induced adrenal insufficiency is highly prevalent, but the clinical consequences are not fully understood. Therefore, the indication of adding stress dosages of glucocorticoid during ongoing anti-inflammatory glucocorticoid treatment remains unclear. The aim of this study was to determine the impact of adrenal function on health-related quality of life (HRQoL) in patients receiving ongoing low-dose prednisolone treatment.
Methods: Cross sectional study of 181 patients treated >6 months with prednisolone for rheumatoid arthritis (RA) (n=103), polymyalgia rheumatica/giant cell arteritis (PMR/GCA) (n=47) or renal transplantation (RTx) (n=31). Patients received ongoing prednisolone treatment, median dose 5 mg/day (range 2.5-20 mg) and were not routinely advised to increase the dose during intercurrent illness or stress. Adrenal function was assessed by ACTH test. HRQoL was evaluated during ongoing prednisolone treatment with SF-36v2 scales General Health and Vitality, AddiQol total score (not RA patients), Fatigue VAS scale (PMR/GCA cohort), and self-reported hospital admissions and doctor’s appointments. Analyses of the impact of stimulated P-cortisol on HRQoL controlling for underlying disease were performed in i) all patients and ii) 128 patients receiving low-dose treatment (≤5 mg/day), respectively.
Results: Adrenal insufficiency was found in 41% of patients (35% low-dose patients). Overall, General Health, Vitality, and AddiQol scores were not associated with stimulated P-cortisol. Mean total AddiQol score was 62.5 (SD 7.7). There was a trend for more medical contacts with lower stimulated P-cortisol (1.17 hospital admissions/year/-100nmol/l, CI95%:-0.05–2.23, P=0.061) and (1.11 doctor’s appointments/year/-100nmol/l, CI95%:-0.14–2.36, P=0.083). In the PMR/GCA subcohort, Fatigue VAS score was higher with lower stimulated P-cortisol (4.8mm/-100nmol/l, CI95%:0.9–8.7, P=0.017) and General Health and Vitality tended to be lower (GH:-3.78 points/-100nmol/l, CI95%:-7.16–-0.40, P=0.029) (VT:-3.96 points/-100nmol/l, CI95% -8.38–0.45, P=0.077). However, low-dose patients had higher Vitality with lower stimulated P-cortisol (3.12/-100nmol/l, CI95%:0.17–6.07, P=0.038).
Conclusion: Glucocorticoid-induced adrenal insufficiency was associated with fatigue and reduced General health in the PMR cohort and a trend for more doctor’s appointments/admissions in the whole cohort, but otherwise poorly associated with HRQoL during ongoing prednisolone treatment. Results can reflect poor HRQoL consequences of glucocorticoid-induced adrenal insufficiency during ongoing (low-dose) prednisolone treatment or insufficient sensitivity of HRQoL instruments with long recall periods rather than daily symptom monitoring during situations of stress.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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