Abstract
ContextPatients with adrenal insufficiency (AI) have excess mortality and morbidity, mainly due to cardiovascular (CV) diseases. The mechanisms for this is unclear.ObjectiveTo assess CV structure and function in AI patients on conventional replacement therapy and after switching to once-daily, modified-release hydrocortisone (OD-HC) in comparison with healthy matched controls.MethodsThis was a retrospective analysis of 17 adult AI patients (11 with primary AI, 6 with secondary AI) on stable replacement with cortisone acetate [median (minimum, maximum) 33.5 (12.5–50) mg] and, if needed, fludrocortisone [0.1 (0.05–0.2) mg], and 17 healthy matched controls. Ten patients were switched to an equivalent dose of OD-HC. Data from echocardiography, 24 h Holter-ECG and 24 h blood pressure monitoring were collected at baseline and 6 months after the switch to OD-HC.ResultsAt baseline, AI patients had smaller left ventricular diastolic diameter (47.1 ± 4.2 vs. 51.6 ± 2.3 mm; P = 0.001) and left atrial diameter (34.9 ± 4.7 vs. 38.2 ± 2.6 cm; P = 0.018), and a higher ejection fraction (62.5 ± 6.9% vs. 56.0 ± 4.7%; P = 0.003) than controls. AI patients had lower nocturnal systolic and diastolic blood pressure than controls (108 ± 15 mmHg vs. 117 ± 8 mmHg; P = 0.038 and 65 ± 9 mmHg vs. 73 ± 7 mmHg; P = 0.008, respectively). After the switch to OD-HC, nocturnal diastolic blood pressure normalised. No significant changes were observed in echocardiographic and Holter-ECG parameters following the switch.ConclusionsAI patients on conventional treatment display cardiovascular abnormalities that could be related to hypovolemia. Switch to OD-HC seems to have beneficial effect on blood pressure profile, but no effect on cardiovascular structure and function.
Highlights
Supplementary information The online version of this article contains supplementary material, which is available to authorized users.Adrenal insufficiency (AI) is a life-threatening disease characterised by impaired secretion of glucocorticoids (GC), with or without mineralocorticoid (MC) deficiency [1]
2 Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden Adrenal insufficiency (AI) is a life-threatening disease characterised by impaired secretion of glucocorticoids (GC), with or without mineralocorticoid (MC) deficiency [1]
A total of 17 patients with AI (13 women, 4 men) and 17 matched healthy controls were included in the study
Summary
Adrenal insufficiency (AI) is a life-threatening disease characterised by impaired secretion of glucocorticoids (GC), with or without mineralocorticoid (MC) deficiency [1]. In patients with primary AI, MC substitution with fludrocortisone is needed [4]. Long-term outcome in patients with AI was for a long time considered to be similar to that of the general population [5, 6]. Recent studies have shown that patients with both primary and secondary AI present higher morbidity and mortality compared to the background population, mainly due to cardiovascular (CV) diseases [7,8,9,10,11]
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