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Dual-release hydrocortisone improves body composition and the glucometabolic profile in patients with secondary adrenal insufficiency.
- Source :
-
Endocrine [Endocrine] 2024 Jun; Vol. 84 (3), pp. 1182-1192. Date of Electronic Publication: 2024 Feb 12. - Publication Year :
- 2024
-
Abstract
- Purpose: Studies have suggested improved metabolic profiles in patients with adrenal insufficiency treated with dual-release hydrocortisone (DR-HC) compared with conventional hydrocortisone (C-HC). This study investigates the effect of DR-HC compared with C-HC treatment on five health variables: diurnal salivary cortisol/cortisone, body composition, bone health, glucose metabolism, lipids, and blood pressure.<br />Methods: Prospective study of 27 participants (24 men) with secondary adrenal insufficiency with measurements during stable C-HC and 16 weeks after treatment switch to DR-HC.<br />Outcomes: Diurnal salivary-cortisol/cortisone, body composition assessed by Dual-Energy X-ray absorptiometry scan, bone status indices (serum type I N-terminal procollagen [PINP], collagen type I cross-linked C-telopeptide [CTX], osteocalcin, receptor activator kappa-B [RANK] ligand, osteoprotegerin, and sclerostin), lipids, haemoglobin A <subscript>1c</subscript> (HbA <subscript>1c</subscript> ), and 24-hour blood pressure.<br />Results: After the switch to DR-HC, the diurnal salivary-cortisol area under the curve (AUC) decreased non-significantly (mean difference: -55.9 nmol/L/day, P = 0.06). The salivary-cortisone-AUC was unchanged. Late-evening salivary-cortisol and cortisone were lower (-1.6 and -1.7 nmol/L, P = 0.002 and 0.004). Total and abdominal fat mass (-1.5 and -0.5 kg, P = 0.003 and 0.02), HbA <subscript>1c</subscript> (-1.2 mmol/mol, P = 0.02), and osteocalcin decreased (-7.0 µg/L, P = 0.03) whereas sclerostin increased (+41.1 pg/mL, P = 0.0001). The remaining bone status indices, lipids, and blood pressure were unchanged.<br />Conclusion: This study suggests that switching to DR-HC leads to lower late-evening cortisol/cortisone exposure and a more favourable metabolic profile and body composition. In contrast, decreased osteocalcin with increasing sclerostin might indicate a negative impact on bones.<br />Clinical Trial Registration: EudraCT201400203932.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Male
Female
Middle Aged
Adult
Prospective Studies
Aged
Blood Glucose drug effects
Blood Glucose metabolism
Blood Pressure drug effects
Cortisone administration & dosage
Cortisone metabolism
Saliva chemistry
Saliva metabolism
Treatment Outcome
Delayed-Action Preparations
Glycated Hemoglobin analysis
Glycated Hemoglobin metabolism
Hydrocortisone blood
Body Composition drug effects
Adrenal Insufficiency drug therapy
Adrenal Insufficiency metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1559-0100
- Volume :
- 84
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Endocrine
- Publication Type :
- Academic Journal
- Accession number :
- 38345683
- Full Text :
- https://doi.org/10.1007/s12020-024-03711-9