SAT-381 Cognitive Function and Quality of Sleep in Patients with Adrenal Insufficiency May Benefit by Therapy with Dual-Release Hydrocortisone

Abstract

Introduction Patients with primary and secondary adrenal insufficiency (PAI/ SAI) are usually treated with glucocorticoid replacement therapy which fails to mimic the circadian rhythm of cortisol secretion thereby resulting in temporary hypo- and hypercortisolism. The unphysiological replacement is associated with impairment in cognitive function. Dual-release hydrocortisone (DR-HC) resembles the daily normal cortisol profile which improves metabolic parameters and quality of life but currently little is known about its impact on cognitive function. Material and Methods Twenty adults with adrenal insufficiency (12 PAI, 8 SAI) treated with DR-HC underwent 10 neuropsychological tests, evaluating intellectual abilities, mindset, memory, executive functioning, attention and alertness. Furthermore, demographic data, quality of life, symptoms of depression and quality of sleep were evaluated by well-established questionnaires (AddiQoL, SF-36, Beck Depression Inventory, Pittsburgh sleep quality index). Patients were split into 2 groups with respect to diagnosis (PAI vs. SAI) and to dosage (≤20mg/d vs. >20 mg/d, defined by median split). Because of use of standardized tests all patients could be compared to healthy controls. Moreover eighteen DR-HC treated adults were compared with eighteen adults on conventional-HC treatment matched for age, sex, education and diagnosis. Results Compared to standard values patients on DR-HC reached improved scores in intellectual abilities (p=0.000) and memory (p=0.001) and impaired scores in alertness (p=0.000). With respect to diagnosis patients with PAI performed better on intellectual abilities (IQ 121.3 vs. 103.8; p=0.038) and on executive functioning (79.2% vs. 45.0%; p=0.026) and reported a longer time to fall asleep (36 min. vs. 12 min.; p=0.026) than patients with SAI. Regarding DR-HC dosage, there was no significant difference in cognitive function. Patients on high dose reported a better subjective quality of sleep (p=0.028) than patients on low dose. In comparison to conventional-HC treatment, patients with DR-HC tended to show better results in executive functioning (59.2% vs. 66.1%; p=0.099). We found no further significant differences between both treatment modalities. Conclusion Patients with PAI reached better results in several cognitive functions and had a worse quality of sleep than patients with SAI. Our data suggest a positive impact of DR-HC on quality of sleep. DR-HC may be better for executive functioning than conventional-HC.