Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency

Guarnotta, V.; Di Stefano, C.; Santoro, A.; Ciresi, A.; Coppola, A.; Giordano, C.

doi:10.1530/EC-19-0176

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Background: Dual-release hydrocortisone (DR-HC) improves metabolism in patients with adrenal insufficiency. The aims of this study were to compare the cardiovascular and metabolic effects of conventional glucocorticoids (GCs) vs. DR-HC and of high vs. low doses of GCs, after 48 months of observation.Methods: We selected 27 patients on hydrocortisone (mean dose 17.5 +/- 4.2 mg/day) and 20 patients on cortisone acetate (mean dose 37.5 +/- 12.1 mg/day) who maintained this treatment (group A) and 53 patients switched to DR-HC (mean dose 22 +/- 4.8 mg/day) (group B). At baseline and after 48 months, clinical and metabolic parameters and Framingham Risk Score (FRS) were obtained.Results: After 48 months, patients in group A had a significant increase from baseline in BMI (P < 0.001), waist circumference (P = 0.001), systolic blood pressure (P = 0.001), LDL cholesterol (P = 0.018), HbA1c (P = 0.020) and FRS (P = 0.002). By contrast, patients in group B had a significant decrease in BMI (P = 0.002), waist circumference (P = 0.015), diastolic blood pressure (P = 0.031), total (P = 0.006) and LDL cholesterol (P = 0.005), HbA1c (P < 0.001) and FRS (P = 0.015) compared to baseline. No significant differences between high and low doses of both conventional GCs and DR-HC were observed.Conclusions: DR-HC is associated with an improvement of metabolic parameters and cardiovascular risk compared to conventional GCs, which are associated with a worsening of these parameters, regardless of the dose used.

Data di pubblicazione:	2019
Titolo:	Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency
Autori:	GUARNOTTA, Valentina Di Stefano C. Santoro A. CIRESI, Alessandro Coppola A. GIORDANO, Carla (Corresponding) mostra contributor esterni nascondi contributor esterni
Citazione:	Guarnotta, V., Di Stefano, C., Santoro, A., Ciresi, A., Coppola, A., & Giordano, C. (2019). Dual-release hydrocortisone vs conventional glucocorticoids in adrenal insufficiency. ENDOCRINE CONNECTIONS, 8(7), 853-862.
Rivista:	ENDOCRINE CONNECTIONS
Digital Object Identifier (DOI):	10.1530/EC-19-0176
Abstract:	Background: Dual-release hydrocortisone (DR-HC) improves metabolism in patients with adrenal insufficiency. The aims of this study were to compare the cardiovascular and metabolic effects of conventional glucocorticoids (GCs) vs. DR-HC and of high vs. low doses of GCs, after 48 months of observation.Methods: We selected 27 patients on hydrocortisone (mean dose 17.5 +/- 4.2 mg/day) and 20 patients on cortisone acetate (mean dose 37.5 +/- 12.1 mg/day) who maintained this treatment (group A) and 53 patients switched to DR-HC (mean dose 22 +/- 4.8 mg/day) (group B). At baseline and after 48 months, clinical and metabolic parameters and Framingham Risk Score (FRS) were obtained.Results: After 48 months, patients in group A had a significant increase from baseline in BMI (P < 0.001), waist circumference (P = 0.001), systolic blood pressure (P = 0.001), LDL cholesterol (P = 0.018), HbA1c (P = 0.020) and FRS (P = 0.002). By contrast, patients in group B had a significant decrease in BMI (P = 0.002), waist circumference (P = 0.015), diastolic blood pressure (P = 0.031), total (P = 0.006) and LDL cholesterol (P = 0.005), HbA1c (P < 0.001) and FRS (P = 0.015) compared to baseline. No significant differences between high and low doses of both conventional GCs and DR-HC were observed.Conclusions: DR-HC is associated with an improvement of metabolic parameters and cardiovascular risk compared to conventional GCs, which are associated with a worsening of these parameters, regardless of the dose used.
URL:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599082/
Settore Scientifico Disciplinare:	Settore MED/13 - Endocrinologia
Appare nelle tipologie:	1.01 Articolo in rivista

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