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Metabolic and cardiovascular profile in patients with Addison's disease under conventional glucocorticoid replacement
R Giordano1, S Marzotti, M Balbo
1Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.
Insights
Addison's disease (AD) patients on standard glucocorticoid replacement show increased central adiposity, impaired glucose tolerance, and dyslipidemia compared to healthy controls. These metabolic changes occur despite normal overall mortality and cardiovascular markers in AD.
Area of Science:
- Endocrinology
- Metabolic Medicine
- Cardiovascular Health
Background:
- Addison's disease (AD) management focuses on glucocorticoid replacement, but its long-term metabolic and cardiovascular effects require further investigation.
- Limited data exist on the impact of conventional glucocorticoid therapy on metabolic and cardiovascular outcomes in AD, unlike secondary hypoadrenalism.
Purpose of the Study:
- To evaluate the metabolic and cardiovascular outcomes in Addison's disease (AD) patients receiving conventional glucocorticoid replacement therapy.
- To compare metabolic parameters, including glucose tolerance and lipid profiles, between AD patients and healthy controls.
Main Methods:
- 38 patients with AD on hydrocortisone or cortisone acetate were assessed for hormonal levels, glucose metabolism, lipid profiles, blood pressure, and intima-media thickness (IMT).
- These AD patients were compared to 38 age-, sex-, and BMI-matched healthy controls (CS).
Main Results:
- AD patients exhibited higher ACTH and plasma renin activity (PRA) and lower DHEAS compared to controls.
- While mean glucose and lipid levels were similar, AD patients showed a higher prevalence of impaired glucose tolerance (IGT), hypercholesterolemia, and hypertriglyceridemia.
- No significant differences were observed in 24-h blood pressure or IMT between AD patients and controls.
Conclusions:
- Addison's disease patients on conventional glucocorticoid replacement have a higher prevalence of central adiposity, impaired glucose tolerance, and dyslipidemia.
- These metabolic derangements appear independent of disease duration or specific hormone levels in AD.
- Cardiovascular risk factors like blood pressure and IMT were not significantly altered in AD patients compared to controls.
Objective:
Although two studies have shown that Addison's disease (AD) is still a potentially lethal condition for cardiovascular, malignant, and infectious diseases, a recent retrospective study showed a normal overall mortality rate. Differently from secondary hypoadrenalism, scanty data exist on the role of conventional glucocorticoid replacement on metabolic and cardiovascular outcome in AD.
Subjects And Methods:
In 38 AD under conventional glucocorticoid replacement (hydrocortisone 30 mg/day or cortisone 37.5 mg/day) ACTH, plasma renin activity (PRA), DHEAS, fasting glucose and insulin, 2-h glucose after oral glucose tolerance test, serum lipids, 24-h blood pressure and intima-media thickness (IMT) were evaluated and compared with 38 age-, sex- and body mass index (BMI)-matched controls (CS).
Results:
AD had ACTH and PRA higher and DHEAS lower (p<0.0005) than CS. Mean waist was higher (p<0.05) in AD than in CS. Although no differences were found for mean gluco-lipids levels, a higher percentage of AD compared to CS were IGT (8 vs 0%), hypercholesterolemic (18 vs 8%), and hypertriglyceridemic (18 vs 8%); none of the AD and CS showed either HDL<40 mg/dl or LDL>190 mg/dl. At the multiple regression analysis, in both AD and CS, BMI was the best predictor of 2-h glucose and age of total and LDL cholesterol; in AD, no significant correlation was found between the above mentioned metabolic parameters and either hormone levels or disease duration. In both AD and CS 24-h blood pressure and IMT were normal.
Conclusions:
Our study shows a higher prevalence of central adiposity, impaired glucose tolerance and dyslipidemia in AD patients.
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