What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study

Purpose The impact of patient’s characteristics on glucocorticoid (GC) replacement therapy in adrenal insufficiency (AI) is poorly evaluated. Aims of this study were to assess the influence of sex and body weight on GC dosing and to describe the choice of GC in AI of different etiologies. Methods We...

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Published in:Journal of endocrinological investigation 2021-04, Vol.44 (4), p.865-872
Main Authors: Puglisi, S., Rossini, A., Tabaro, I., Cannavò, S., Ferrau’, F., Ragonese, M., Borretta, G., Pellegrino, M., Dughera, F., Parisi, A., Latina, A., Pia, A., Terzolo, M., Reimondo, G.
Format: Article
Language:English
Subjects:
Acetic acid
Body weight
Dosage
Endocrinology
Etiology
Glucocorticoids
Hydrocortisone
Internal Medicine
Medicine
Medicine & Public Health
Metabolic Diseases
Original
Original Article
Patients
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Summary:Purpose The impact of patient’s characteristics on glucocorticoid (GC) replacement therapy in adrenal insufficiency (AI) is poorly evaluated. Aims of this study were to assess the influence of sex and body weight on GC dosing and to describe the choice of GC in AI of different etiologies. Methods We retrospectively evaluated hydrocortisone (HC) equivalent total daily dose (HC-TDD) and per-kg-daily dose (HC-KDD) in 203 patients (104 primary AI [pAI], 99 secondary AI [sAI]) followed up for ≥ 12 months. They were treated with HC, modified-release HC (MRHC) or cortisone acetate (CA) and fludrocortisone acetate (FCA) in pAI. Results At baseline, CA was preferred both in pAI and sAI; at last visit, MRHC was most used in pAI (49%) and CA in sAI (73.7%). Comparing the last visit with baseline, in pAI, HC-TDD and HC-KDD were significantly lower ( p  = 0.04 and p  = 0.006, respectively), while FCA doses increased during follow-up ( p  = 0.02). The reduction of HC-TDD and HC-KDD was particularly relevant for pAI women ( p  = 0.04 and p  = 0.002, respectively). In sAI patients, no change of HC-KDD and HC-TDD was observed, and we found a correlation between weight and HC-TDD in males ( r 0.35, p  = 0.02). Conclusions Our real-life study demonstrated the influence of etiology of AI on the type of GC used, a weight-based tailoring in sAI, a likely overdosage of GC treatment in pAI women at the start of treatment and the possibility to successfully increase FCA avoiding GC over-treatment. These observations could inform the usual clinical practice.
ISSN:1720-8386
0391-4097
1720-8386
DOI:10.1007/s40618-020-01386-3