Abstract
Patients with Addison’s disease have relatively high rates of depression and anxiety symptoms compared with population-based reference samples. Addison’s disease results in deficiency of dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S). There is considerable debate about the specific effects of DHEA deficiency on energy level and mood. We measured emotional well-being in 16 patients with Addison’s disease and a group of 16 hospital attendees with type 2 diabetes. Participants completed the General Health Questionnaire-28 (GHQ-28), the Hospital Anxiety and Depression Scale (HADS), the World Health Organization’s quality of life assessment (WHOQOL-BREF) and the Holmes–Rahe life event scale. DHEA-S was low in Addison’s patients (Addison’s men: 0.5 ± 0.1 μmol/l [normal range: 2.1–10.8] compared with diabetes men: 3.2 ± 1.2 μmol/l; Addison’s women: 0.4 ± 0.01 μmol/l [normal range: 1.0–11.5] compared with diabetes women: 2.2 ± 0.71 μmol/l). Testosterone levels were similar in both groups studied. There were no differences in emotional well-being and quality of life (QOL) between patients with Addison’s disease and Type 2 Diabetes Mellitus as measured by GHQ-28 (Addison’s: 22.4 ± 2.6, Diabetes: 19.6 ± 2.7), HADS Depression (Addison’s: 5.4 ± 0.9, Diabetes: 4.5 ± 1.4), HADS Anxiety and WHOQOL-BREF. There were no gender differences in affective symptomatology within the Addison’s group. Life event scores were above average in both groups (Addison’s: 195 ± 39.6, Diabetes: 131 ± 43.8), but not significant for difference between groups as was GHQ-28 total score. Both groups scored highly on the GHQ-28 and the life event scale, indicative of poorer health perceptions than the general population. This could be due to the chronicity of both disorders. We have not identified any specific effects of DHEA-S deficiency on mood or QOL.
Highlights
Addison’s disease is described as a clinical syndrome presenting with fatigue, anorexia, wasting, and hyperpigmentation
An explanation that has been proposed for the results reported by Løvås et al (2002) is that the impaired quality of life (QOL) experienced by Addison’s patients is secondary to a reduction in the synthesis of DHEA and DHEA-sulfate (DHEA-S)
BMI was higher in the male diabetes group than their respective Addisonian counterparts but similar in both female Addison’s and diabetes groups. 81% of Addison’s patients and 61% of type 2 diabetes patients approached agreed to participate in the study
Summary
Addison’s disease is described as a clinical syndrome presenting with fatigue, anorexia, wasting, and hyperpigmentation. Addison’s disease results in deficiency of dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEAS) in addition to glucocorticoids and mineralocorticoids (Arlt and Allolio, 2003). Løvås et al (2002) compared the subjective health status of a large group of Addison’s patients to a population based reference sample. Despite the fact that many had been taking longstanding replacement therapy, they reported a reduced general health perception, decreased vitality and increased fatigue based on the evidence from the Short Form-36 and the Fatigue questionnaires. An explanation that has been proposed for the results reported by Løvås et al (2002) is that the impaired QOL experienced by Addison’s patients is secondary to a reduction in the synthesis of DHEA and DHEA-sulfate (DHEA-S)
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