Endocrine Abstracts

Introduction: Glucocorticoid replacement therapy may result in long-term morbidities, including cardiovascular diseases which can increase cardiovascular risk. The study was aimed to assess the impact of life-long glucocorticoid replacement therapy on cardiovascular parameters in patients with Addison disease (AD).

Patients and Methods: This cross-sectional study was conducted assess cardiovascular events in patients followed for AD for at least 5 years, in the Endocrinology department of Hedi Chaker University hospital, Sfax, Tunisia, from March 2020 to July 2021.

Results: The mean age of patients was 49.5±13.9 years (18-78 years) with glucocorticoid replacement duration of 13.9 ±8.7 years (5-35 years). High blood pressure (52%) and diabetes mellitus (52%) were the most prevalent family histories. No patient had hypertension or carbohydrate metabolism disorder at the time of AD diagnosis. Average body mass index (BMI) was 28.1 kg/m^² (21.2-45.8 kg/m^²). Overweight and obesity were recorded in 48% and 26% of patients, respectively. Carbohydrate metabolism disorder was depicted in 38% of patients after a mean glucocorticoid replacement duration of 17.5±5.4 years. Among those patients, 31.6% developed type 2 diabetes. Patients with diabetes type 2 diabetes had longer duration of glucocorticoid use (19.8 ±9.9 years vs 13.2 ±8.4 years, P=0.1) and higher daily and cumulative glucocorticoid dose (27.5±5 mg/day vs 25.6 ±6.9 mg/day, P=0.4; 506, 2±277, 2 mg vs 355, 4±282, 9 mg P=0.1) than those with normoglycemia, but without significant correlation. Sixteen percent of patients developed hyperlipidemia after a mean glucocorticoid replacement duration of 13.6 years (mixed dyslipidemia in 5 patients, isolated hypercholesterolemia in one patient, hypertriglyceridemia in 2 patients and low HDL-cholesterol level in 5 patients). As well, patients having disturbed lipid balance had higher daily glucocorticoid dose but without significant difference (26.5±7.1 mg/day vs 25.6±6.7 mg/day,P=0.7). Hypertension occurred in 14% of patients after a mean glucocorticoid use duration of 9.5 years (2-21 years) and two patients developed coronary artery disease. There was no significant correlation between hypertension and cumulative hydrocortisone dose nor duration of glucocorticoid replacement therapy. Metabolic syndrome was noted in 24% of patients and its occurrence was significantly correlated with daily hydrocortisone dose (26.9 ±6.6 mg/day vs 22.3 ±5.9 mg/day, P=0.04).

Conclusion: Our results underline the importance of close monitoring of cardiovascular risk factors in patients with AD in order to reduce cardiovascular repercussions of long-term glucocorticoid replacement therapy.