Endocrine Abstracts

JOINT316

Introduction: Patients with adrenal insufficiency (AI) have been shown to suffer from an increased susceptibility to infections. Conventional hydrocortisone replacement therapy may be the main cause as it is associated with temporary cortisol under- and overexposure leading to immunodysregulation and -suppression. Both effects may be reduced with dual-release hydrocortisone (Plenadren®), which improves the adaption to the circadian rhythm of cortisol. Aim of this study was to assess the effect of different hydrocortisone preparations on infection rates and thus also on the number of adrenal crisis (AC).

Material and methods: Patients with AI were contacted via a group practice for endocrinology, several self-helping groups in Northern Germany and the online network ‘Glandula’. The test subjects were given a self-developed questionnaire regarding their infections in the past year, AC since their diagnosis and their glucocorticoid replacement dosage. The results were analyzed using Excel and SPSS.

Results: Eighty-eight patients (84% women, 16% men) with primary (53.4%), secondary (43.2%) and tertiary (3.4%) AI participated in this study. The results showed a 56.8% reduction in infections over 12 months in patients with Plenadren® compared to conventional hydrocortisone (P=0.012). Furthermore, patients with secondary AI had 56.4% more infections than those with primary AI (P=0.04). Overall, even though patients with Plenadren® had significantly higher medication doses (23.2 vs. 25.7 mg; P=0.022), no dosage-effect could be shown on the frequency of infections. Regarding the ACs, no differences were observed between the medications.

Conclusions: Our study suggests that the improved cortisol exposure under Plenadren® may indeed lead to fewer infections. However, this did not result in a lower rate of AC. The impact of glucocorticoid replacement dosage in the prevention of infections and AC remains unclear underlining the need of further confirmatory studies.