Patients with adrenal insufficiency have cardiovascular features associated with hypovolemia

• Published in: Endocrine Vol. 70; no. 2; pp. 412 - 420
• Main Authors: Esposito, Daniela, Bobbio, Emanuele, Di Fraia, Rosa, Mone, Pasquale, Accardo, Giacomo, De Bellis, Annamaria, Iorio, Sergio, Esposito, Katherine, Marfella, Raffaele, Johannsson, Gudmundur, Ragnarsson, Oskar, Pasquali, Daniela
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2020; Springer Nature B.V
• Subjects: Acetic acid; addisons-disease; Adrenal insufficiency; adults; Blood; Blood pressure; Cardiac and Cardiovascular Systems; Cardiovascular system; Diabetes; dual-release hydrocortisone; Echocardiography; EKG; Endocrinology; Endocrinology & Metabolism; females; glucocorticoid replacement; Heart; Humanities and Social Sciences; Hydrocortisone; hypopituitarism; Internal Medicine; Kardiologi; Medicine; Medicine & Public Health; Modified-release hydrocortisone; Morbidity; mortality; multidisciplinary; Original; Original Article; premature; pressure profile; profile; Science; Structure-function relationships; therapy; Ventricle; Cardiovascular system; Blood pressure profile; Adrenal insufficiency; Echocardiography; Modified-release hydrocortisone
• ISSN: 1355-008X; 1559-0100
• DOI: 10.1007/s12020-020-02458-3

Context Patients with adrenal insufficiency (AI) have excess mortality and morbidity, mainly due to cardiovascular (CV) diseases. The mechanisms for this is unclear. Objective To assess CV structure and function in AI patients on conventional replacement therapy and after switching to once-daily, modified-release hydrocortisone (OD-HC) in comparison with healthy matched controls. Methods This was a retrospective analysis of 17 adult AI patients (11 with primary AI, 6 with secondary AI) on stable replacement with cortisone acetate [median (minimum, maximum) 33.5 (12.5–50) mg] and, if needed, fludrocortisone [0.1 (0.05–0.2) mg], and 17 healthy matched controls. Ten patients were switched to an equivalent dose of OD-HC. Data from echocardiography, 24 h Holter-ECG and 24 h blood pressure monitoring were collected at baseline and 6 months after the switch to OD-HC. Results At baseline, AI patients had smaller left ventricular diastolic diameter (47.1 ± 4.2 vs. 51.6 ± 2.3 mm; P  = 0.001) and left atrial diameter (34.9 ± 4.7 vs. 38.2 ± 2.6 cm; P  = 0.018), and a higher ejection fraction (62.5 ± 6.9% vs. 56.0 ± 4.7%; P  = 0.003) than controls. AI patients had lower nocturnal systolic and diastolic blood pressure than controls (108 ± 15 mmHg vs. 117 ± 8 mmHg; P  = 0.038 and 65 ± 9 mmHg vs. 73 ± 7 mmHg; P  = 0.008, respectively). After the switch to OD-HC, nocturnal diastolic blood pressure normalised. No significant changes were observed in echocardiographic and Holter-ECG parameters following the switch. Conclusions AI patients on conventional treatment display cardiovascular abnormalities that could be related to hypovolemia. Switch to OD-HC seems to have beneficial effect on blood pressure profile, but no effect on cardiovascular structure and function.