Continuous Subcutaneous Hydrocortisone Infusion versus Oral Hydrocortisone Replacement for Treatment of Addison's Disease: A Randomized Clinical Trial

Øksnes, Marianne; Björnsdóttir, Sigríður; Isaksson, Magnus; Methlie, Paal; Carlsen, Siri; Nilsen, Roy Miodini; Broman, Jan‐Erik; Triebner, Kai; Kämpe, Olle; Hulting, Anna‐Lena; Bensing, Sophie; Husebye, Eystein S.; Løvås, Kristian

doi:10.1210/jc.2013-4253

Cited by 109 publications

(82 citation statements)

References 34 publications

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“…The importance of mimicking the circadian rhythm of cortisol secretion in patients with AI is supported by a study of Johannsson et al (41), which demonstrated that in patients treated with once-daily dual-release hydrocortisone tablets, a more circadianbased cortisol profile and more favorable scores on questionnaires assessing psychological well-being and fatigue were observed, compared with patients treated with conventional hydrocortisone treatment. Furthermore, both Løvås & Husebye (42) and Oksnes et al (43) reported that continuous hydrocortisone infusion in patients with PAI resulted in cortisol and ACTH levels toward normal circadian levels and positively affected QoL. These two studies suggest that the physiological profile might be related to QoL outcomes.…”

Section: Discussionmentioning

confidence: 95%

Psychological morbidity and impaired quality of life in patients with stable treatment for primary adrenal insufficiency: cross-sectional study and review of the literature

Tiemensma¹,

Andela²,

Kaptein³

et al. 2014

European Journal of Endocrinology

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Context: A high prevalence of psychological morbidity and maladaptive personality as well as impaired quality of life (QoL) is observed in patients with and without hydrocortisone dependency following (cured) Cushing's syndrome. However, it is currently unclear whether a similar pattern is present in patients with chronic glucocorticoid replacement for primary adrenal insufficiency (PAI). Objective: To evaluate psychological functioning, personality traits, and QoL in patients with PAI. Design and subjects: A cross-sectional study including 54 patients with stable treatment for PAI and 54 healthy matched controls. Both patients and controls completed questionnaires on psychological functioning (Apathy Scale, Irritability Scale, Mood and Anxiety Symptoms Questionnaire short form, and Hospital Anxiety and Depression Scale), personality traits (Dimensional Assessment of Personality Pathology short form), and QoL (Multidimensional Fatigue Inventory, Short Form 36, EuroQoL-5D, Nottingham Health Profile, and Physical Symptom Checklist). Results: Patients with PAI suffered from more psychological morbidity (i.e. irritability and somatic arousal) and QoL impairments compared with controls (all P!0.01). There were no differences regarding maladaptive personality traits between patients and controls. However, there was a strong and consistent positive association between the daily hydrocortisone dose and prevalence of maladaptive personality traits (i.e. identity problems, cognitive distortion, compulsivity, restricted expression, callousness, oppositionality, rejection, conduct problems, social avoidance, narcissism, and insecure attachment, all P!0.05). There was also a strong relation between the mean daily hydrocortisone dose and both psychological morbidity (i.e. depression, P!0.05) and QoL impairments (i.e. general health perception, several measures of physical functioning, and vitality, all P!0.05). Conclusion: Patients on stable glucocorticoid replacement therapy for PAI report psychological morbidity and impaired QoL. Psychological morbidity, impaired QoL, and maladaptive personality traits were all associated with higher dosages of hydrocortisone.

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Section: Discussionmentioning

confidence: 95%

Psychological morbidity and impaired quality of life in patients with stable treatment for primary adrenal insufficiency: cross-sectional study and review of the literature

Tiemensma¹,

Andela²,

Kaptein³

et al. 2014

European Journal of Endocrinology

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“…A cross-over study of 33 patients comparing thrice daily oral hydrocortisone and CSHI over 12 weeks has reported higher waking salivary cortisol and better control of overnight ACTH levels during pump therapy. 34 Disease-specific quality…”

Section: New Developmentsmentioning

confidence: 99%

Adrenal insufficiency – recognition and management

Pazderska

Pearce

2017

Clinical Medicine

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Adrenal insuffi ciency is characterised by inadequate glucocorticoid production owing to destruction of the adrenal cortex or lack of adrenocorticotropic hormone stimulation. In primary adrenal insuffi ciency, lack of mineralocorticoids is also a feature. Patients can present with an insidious onset of symptoms, or acutely in adrenal crisis, which requires prompt recognition and treatment. Chronic glucocorticoid therapy is the most common cause of adrenal insuffi ciency. The diagnosis of adrenal insuffi ciency is made by demonstrating low basal and/or stimulated serum cortisol and should be followed by appropriate investigations to establish the underlying aetiology. Maintenance glucocorticoid replacement is usually given as a twice or thrice daily hydrocortisone preparation. Patients with primary adrenal insuffi ciency also require mineralocorticoid. Regular monitoring for features of underand over-replacement is essential during follow-up. Patient education is a key feature of management of this condition. IntroductionThe adrenal cortex secretes the essential steroid hormones, cortisol and aldosterone, under the control of pituitary adrenocorticotropic hormone (ACTH), angiotensin II and plasma potassium. The most frequent cause of adrenal insufficiency is exogenous steroid use. Up to 2.5% of the population are taking such steroid medications for inflammatory or immune-mediated conditions. 1 These individuals are vulnerable to steroid deficiency if the medication is stopped suddenly. ACTH deficiency (secondary adrenal insufficiency) as a result of pituitary tumours, infiltrative diseases, head injury or congenital hypopituitarism is the next most frequent cause, present in around 1 per 3,000 individuals. 2High dose opiates, which frequently induce hypogonadotropic hypogonadism, are also increasingly recognised as a cause of hypothalamic-pituitary-adrenal (HPA) suppression.3 By comparison, primary adrenal insufficiency is rare, with a prevalence of 1 in 8,000 people. 4 In developed nations, an autoimmune attack directed against the adrenal steroidogenic enzymes (predominantly 21-hydroxylase) 5 accounts for about 85% of cases. Around 60% of patients with autoimmune ABSTRACT Adrenal insuffi ciency -recognition and managementAddison's disease have an additional autoimmune condition, most frequently autoimmune thyroid disease or type 1 diabetes.

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“…Recently, the disease-specific questionnaire AddiQoL was developed (40) and validated (41) as an evaluative tool in PAI, which might facilitate the detection of minor changes in well-being in future clinical trials and during routine follow-up of patients (42,43,44,45).…”

Section: Health-related Quality Of Lifementioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review

Bensing

Hulting

Husebye

et al. 2016

European Journal of Endocrinology

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In this article, we review published studies covering epidemiology, natural course and mortality in primary adrenal insufficiency (PAI) or Addison's disease. Autoimmune PAI is a rare disease with a prevalence of 100-220 per million inhabitants. It occurs as part of an autoimmune polyendocrine syndrome in more than half of the cases. The patients experience impaired quality of life, reduced parity and increased risk of preterm delivery. Following a conventional glucocorticoid replacement regimen leads to a reduction in bone mineral density and an increase in the prevalence of fractures. Registry studies indicate increased mortality, especially evident in patients diagnosed with PAI at a young age and in patients with the rare disease autoimmune polyendocrine syndrome type-1. Most notably, unnecessary deaths still occur because of adrenal crises. All these data imply the need to improve the therapy and care of patients with PAI.

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Continuous Subcutaneous Hydrocortisone Infusion versus Oral Hydrocortisone Replacement for Treatment of Addison's Disease: A Randomized Clinical Trial

Cited by 109 publications

References 34 publications

Psychological morbidity and impaired quality of life in patients with stable treatment for primary adrenal insufficiency: cross-sectional study and review of the literature

Psychological morbidity and impaired quality of life in patients with stable treatment for primary adrenal insufficiency: cross-sectional study and review of the literature

Adrenal insufficiency – recognition and management

MANAGEMENT OF ENDOCRINE DISEASE: Epidemiology, quality of life and complications of primary adrenal insufficiency: a review

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