Session: SAT 26-40-Glucocorticoid Actions & Disease
Poster Board SAT-34
Conventional glucocorticoid replacement therapies result in unphysiological variation in plasma cortisol levels; concern has been raised regarding long-term metabolic consequences. Glucocorticoid replacement is technically feasible by continuous subcutaneous hydrocortisone infusion (CSHI), which can mimic the normal diurnal cortisol rhythm. The aim of this study was to compare insulin sensitivity in patients with Addison’s disease (AD) on CSHI vs. three daily doses of oral hydrocortisone (OHC).
Design, Subjects, Measurements
This was an open randomised, cross-over trial, comparing 3 months of weight adjusted OHC with 3 months on CSHI in 33 AD patients. Treatment A was OHC with weight-adjusted doses as suggested by Mah et al (1). Treatment B was CSHI using Solu-Cortef® (50mg/ml) with a body surface area adjusted dose (10mg/m2/24hrs). Patients were examined at baseline and after 2 and 3 months of each treatment. Insulin sensitivity was determined after 2 month of each treatment in 15 Swedish patients using the euglycemic hyperinsulinemic clamp technique (40mU/m2). Whole-body insulin sensitivity (glucose disposal), M value, was calculated from the amount of glucose infused during the last 30 min of the clamp divided by body weight (kg) and period (min) and expressed as mg/kg/min. We also assessed fasting insulin sensitivity, in all 33 patients, using HOMA and the insulin resistance index (HOMA-IR) calculated as ((fasting plasma glucose [mmol/L] x fasting serum insulin [μU/mL]) /22.5). Statistical analyses were performed with linear mixed effects models with random intercepts.
Twenty-five women and 8 men mean±SD, age 48±12 and AD duration 12±10 years participated in the study. The median dose of OHC was 0.23 mg/kg/day, (range; 0.2-0.5) and 0.28 mg/kg/24h, (0.24-0.5) in CSHI.
Body Mass index (BMI) and log HOMA index slightly increased during CSHI (p for trend 0.037 and 0.011), but compared with OHC no significant difference was found (p for interaction 0.085 and 0.19). No difference was found in insulin sensitivity, M-value (p= 0.59). There were no treatment differences over time in waist-hip ratio, (p for interaction 0.24) systolic or diastolic blood pressure (p for interaction 0.73 and 0.94).
CSHI replacement over a three-month period does not influence antropometric measures, blood pressure, or insulin sensitivity, compared with OHC. More randomized trials on long-term effects of CSHI replacement on cardiovascular parameters are needed.
Nothing to Disclose: SB, MO, MI, RMN, ESH, KL, OK, ALH, TN, SB
*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm
See more of: Abstracts - Orals, Featured Poster Presentations, and Posters