Metabolic and cardiovascular profile in patients with Addison’s disease under conventional glucocorticoid replacement

Giordano, Roberta; Marzotti, Stefania; Balbo, M.; Romagnoli, Serena; Marinazzo, Elisa; Berardelli, Rita; Migliaretti, Giuseppe; Benso, Andrea; Falorni, Alberto; Ghigo, Ezio; Arvat, Emanuela

doi:10.1007/bf03345773

Cited by 67 publications

(52 citation statements)

References 34 publications

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“…Moreover, a higher prevalence of central adiposity, impaired glucose tolerance and dyslipidemia, recognized as independent risk factors for cardiovascular disease, have been demonstrated in several studies during treatment [10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison’s disease

et al. 2015

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Disclosure statement: The Authors have nothing to disclose. 2Abstract Purpose: In patients with Addison's disease (AD), a dual-release preparation of hydrocortisone (Plenadren, PLEN) has been demonstrated to maintain cortisol levels in a more physiological range than conventional glucocorticoid therapy, and to exert positive effects. This study aimed to assess variations of anthropometric, metabolic and hormonal parameters in patients with AD after switching from conventional hydrocortisone (HC) treatment to PLEN.Methods: in nineteen AD patients (15 F and 4 M, age 27-65 yr) treated with HC 20 mg/day thrice daily, body weight, BMI, waist circumference, fasting glucose, HbA1c, serum lipids, plasma renin activity (PRA), electrolytes and blood pressure were evaluated at baseline, and 1, 3, 6 and 12 months after switching from HC to PLEN. At baseline, and after 1 and 12 months of PLEN, blood ACTH and cortisol (at 0800 h at fasting, and 30, 60, 90, 120 and 240 minutes after drug ingestion), and health-related quality of life (HRQoL), using 30-AddiQoL questionnaire, were evaluated.Results: During PLEN, waist and serum lipid progressively decreased. After 12 months of PLEN, a significant difference was observed in waist circumference (P=0.007), HbA1c (P=0.002), total and LDL-cholesterol levels (P<0.05). ACTH levels at 240 minutes and the area under the curve (AUC) were lower (P<0.05) during PLEN than HC, while cortisol peaks and AUC were similar. 30-AddiQoL total score also improved (P=0.04) during PLEN.Conclusions: In Addison's disease patients, PLEN reduces central adiposity, and improves glucose and metabolism parameters and HRQoL.3

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Section: Discussionmentioning

confidence: 99%

Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison’s disease

et al. 2015

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“…Lipid status has been assessed in a number of DHEA replacement trials, but overall no significant baseline abnormalities or effects of the treatment have been noted. Some studies reported a slight increase in HDL cholesterol (76,77), whereas others have found more dyslipidaemia in patients with PAI than in controls (81,87). A description of the drug prescription patterns in Sweden showed a higher use of lipid lowering agents among PAI patients compared with population controls (15).…”

Section: Metabolismmentioning

confidence: 97%

“…normal fasting glucose levels, but a higher percentage of impaired glucose tolerance than in controls (81). Studies in secondary adrenal insufficiency indicate that altered circadian cortisol patterns during replacement therapy affect both carbohydrate and lipid metabolism (82,83), but the effects of glucocorticoid and growth hormone failure and their replacement are hard to distinguish.…”

Section: Metabolismmentioning

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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“…In a study of 38 AD patients, Giordano et al showed a higher proportion of patients who were hypercholesterolaemic and hypertriglyceridaemic than their matched controls [7]. Leelarathna and co-workers found a significant proportion of AD patients with dyslipidaemia [8], whereas Gurnell et al reported normal lipid profiles in 100 patients with AD [9].…”

Section: Introductionmentioning

confidence: 98%

Cardiovascular Risk Factors in Patients with Addison's Disease: A Comparative Study of South African and Swedish Patients

et al. 2014

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BackgroundPatients with Addison's disease (AD) in Scandinavia have an increased risk for premature death due to cardiovascular disease (CVD). Serum lipids are important risk factors for CVD and vascular mortality. Replacement doses of hydrocortisone have historically been higher in Sweden than South Africa. The primary aim was to study the lipid profiles in a large group of patients with AD with the hypothesis that the lipid profile in patients in Sweden would be worse than in South Africa.MethodsIn a cross-sectional study, 110 patients with AD (55 from South Africa, 55 from Sweden) matched for age, gender, ethnicity and BMI were studied. Anthropometric measures, blood pressure, lipids, highly sensitive C-reactive protein (hs-CRP) and adiponectin were studied.ResultsAll patients were Caucasian and the majority were women N = 36 (65.5%). Mean (standard deviation; SD) ages of the Swedish and South African patients were 52.9 (13.0) and 52.6 (14.4) years and BMI 25.3 (3.2) and 25.8 (4.1) kg/m2, respectively. The mean total daily hydrocortisone dose was greater in the Swedish patients than the South African patients, [33.0 (8.1) versus 24.3 (8.0) mg; p<0.0001]. South African patients had higher median (interquartilerange; IQR) triglycerides (TG) [1.59 (1.1–2.46) versus 0.96 (0.74–1.6) mmol/l; p<0.001], total cholesterol (TC) [6.02(1.50) versus 5.13 (0.87) mmol/l; p<0.001], LDL-C [4.43 (1.44) versus 2.75 (0.80) mmol/l; p<0.001] and median hs-CRP [2.15 (0.93–5.45) versus 0.99 (0.57–2.10) mg/L; p<0.003] and lower HDL-C [0.80 (0.40) versus 1.86 (0.46) mmol/l; p<0.001] than the Swedish patients. Approximately 20% of the patients in both cohorts had hypertension and diabetes mellitus.ConclusionsSouth African patients with AD have worse lipid profiles and higher hs-CRP compared to their matched Swedish patients, despite lower doses of hydrocortisone. It is uncertain at this time whether these are due to genetic or environmental factors.

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Metabolic and cardiovascular profile in patients with Addison’s disease under conventional glucocorticoid replacement

Abstract: Our study shows a higher prevalence of central adiposity, impaired glucose tolerance and dyslipidemia in AD patients.

Cited by 67 publications

References 34 publications

Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison’s disease

Improvement of anthropometric and metabolic parameters, and quality of life following treatment with dual-release hydrocortisone in patients with Addison’s disease

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

Cardiovascular Risk Factors in Patients with Addison's Disease: A Comparative Study of South African and Swedish Patients

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