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Impaired subjective health status in chronic adrenal insufficiency -impact of different glucocorticoid replacement regimens

B Bleicken, Clinical Endocrinology, Charite University Medicine Berlin, Berlin, Germany
S Hahner, Endocrinology and Diabetes, University of Wuerzburg, Wuerzburg, Germany
M Loeffler, Endocrinology and Diabetes, University of Wuerzburg, Wuerzburg, Germany
M Ventz, Clinical Endocrinology, Charite University Medicine Berlin, Berlin, Germany
B Allolio, Endocrinology and Diabetes, University of Wuerzburg, Wuerzburg, Germany
M Quinkler, Clinical Endocrinology, Charite Campus Mitte, Berlin, 0117, Germany

Correspondence: Marcus Quinkler, Email: marcus.quinkler{at}charite.de

Abstract

Context: Recent studies have suggested that current glucocorticoid replacement therapies fail to fully restore well-being in patients with adrenal insufficiency (AI).

Objective: To investigate the effect of different glucocorticoid preparations used for replacement therapy on subjective health status (SHS) in AI.

Design and Patients: In a cross-sectional study, primary and secondary AI patients were contacted by mail. Individual glucocorticoid replacement regimens, underlying diagnoses and comorbidities were verified by questionnaires and review of medical records. Patients were asked to complete three validated self-assessment questionnaires (Short Form 36 (SF-36), Giessen Complaint List (GBB-24), Hospital Anxiety and Depression Scale (HADS)). Results were compared to sex- and age-matched controls drawn from the questionnaire-specific reference cohort.

Results: 883 patients were identified, and 526 agreed to participate. Completed questionnaire sets were available from 427 patients (primary AI n=232; secondary AI n=195). AI patients showed significantly impaired SHS compared to controls irrespective of the glucocorticoid used for replacement. The only difference in SHS between patients on prednisolone and hydrocortisone (all patients and sub-analysis for primary AI) was significant higher bodily pain (lower Z-score in SF-36) in patients on prednisolone (p<0.05, p<0.01 respectively). In patients with secondary AI the prednisolone group showed significantly (p<0.05) less heart complaints (lower Z-score) in the GBB questionnaire compared to the cortisone acetate group.

Conclusions: Glucocorticoid replacement therapy with prednisolone seems to be equivalent to hydrocortisone regarding subjective health status in patients with AI. However, SHS remains impaired in all patient groups suggesting a need for further improved glucocorticoid replacement strategies.