Once-daily dual-release hydrocortisone improves metabolic profile in adrenal insufficiency

Takeaway

• Patients with primary and secondary adrenal insufficiency (AI) along with normal glucose tolerance or pre-diabetes showed improved BMI, waist circumference (WC), HbA1c and high-density lipoprotein-cholesterol (HDL-C) after 36-month therapy with once-daily dual-release hydrocortisone (DR-HC).
• Patients with AI and pre-diabetes had added advantage of improved insulin secretion and sensitivity.

Why this matters

• Conventional glucocorticoid treatment expose patients to higher cortisol levels leading to increased hypertension, disturbance in sleep pattern and other risks.

Study design

• This retrospective study evaluated 49 patients with primary or secondary AI who were receiving conventional glucocorticoid treatment at baseline.
• 25 and 24 patients within the cohort had normal glucose tolerance and pre-diabetes, respectively.
• Patients were switched to DR-HC therapy for 36 months.
• Funding: None.

Key results

• During 36 months of DR-HC therapy, patients with AI and NGT showed significantly decreased BMI (P=.017), WC (P=.008) and HbA1c (P=.034) and increased HDL-C (P=.036).
• BMI (P<.001), WC (P<.001) and HbA1c (P=.001) reduced, whereas HDL-C (P=.043) increased, significantly for patients with AI and pre-diabetes as well.
• In addition, patients with pre-diabetes showed a significant decrease in insulinaemia (P=.014), and visceral adiposity index (P=.001), with a concomitant increase in oral disposition index (P=.041) and Matsuda index of insulin sensitivity (P=.038).

Limitations

• Retrospective design.
• Small study population.