Endocrine Abstracts

JOINT1515

Primary adrenal insufficiency (PAI) requires lifelong steroid substitution however, standard replacement regimens do not perfectly mimic the physiological glucocorticoid secretion. Under-replacement is life-threatening, while long-term steroid excess leads to adverse effects, including metabolic consequences, which may contribute to increased mortality. The current study was designed to assess the frequency of the metabolic syndrome (MS) in patients conventionally treated for PAI. General Polish population displays 33% and 39% prevalence of MS in women and men, respectively. This cross-sectional analysis comprised 239 individuals (69 males, 170 females) suffering from PAI. Their mean age was 48.2±14.8 years and mean disease/treatment duration 10.8±11.2 years. All patients were on hydrocortisone (HC): mean daily HC dose was 23.1±7.1 mg, adjusted for body mass 0.34±0.12 mg/day/kg, and cumulative HC dose was 94.6±98.1 g during treatment. Central obesity (waist circumference 94/80 cm) was found in 148 (61.9%) patients (123 females and 25 males), hypertension in 37 (15.5%), decreased circulating HDL cholesterol in 64 (26.8%), elevated triglycerides in 90 (37.6%), and hyperglycemia in 57 (23.8%) individuals (19 prediabetes, 15 type 2 diabetes, 23 type 1 diabetes). Overall, 62 (25.9%) subjects displayed MS, including 54 (31.8%) females and 8 (11.6%) males (P=0.0013), however, mean age in the studied women was also significantly higher (51.7±13.8 vs. 39.7±13.7 years; P<0.0001). Female were older, but their PAI onset was also later than males (40.7±13.2 years vs. 30.1±12.0 years; P<0.0001), therefore mean treatment duration remained similar in both sexes (P=0.3717). Once pre- and postmenopausal women were considered, the proportion of MS reached 14.7% and 43.1%, respectively (P<0.0001). Daily HC doses were similar in patients with and without MS (P=0.3382), however, once total HC dose was evaluated, MS patients displayed significantly higher cumulative HC intake (123.4±112.4 vs. 84.5±90.8 g, P=0.0088), which supports the primordial role of disease duration. Finally, in a multiple linear regression model comprising age, disease duration, gender, PAI form (isolated or polyglandular) and HC dosage, only age appeared significant predictor of MS (P<0.001). In conclusion, MS does not specifically affect patients with PAI, however, post-menopausal women seem at increased risk. This is mainly due to their advanced age, and obviously lack of protective estrogen effects, while HC treatment within the current dose recommendations does not seem primordial for MS development. Therefore, conventional but still reasonable HC dosage in PAI does not imply considerably elevated risk for MS, although postmenopausal women should be carefully monitored with this regard.