Continuous Subcutaneous Hydrocortisone Infusion in Adrenal Insufficiency: Practical Experience in 33 Subjects

Diminished subjective health status and increased mortality have been reported in people with adrenal insufficiency (pwAI) receiving conventional glucocorticoid replacement therapy. Continuous subcutaneous hydrocortisone infusion (CSHI) permits individualized glucocorticoid delivery and mimics a more physiologic cortisol pattern compared with oral glucocorticoid therapy. However, data are limited regarding patient selection for CSHI, optimal dosing of CSHI, and CSHI impact on relevant clinical outcomes.

We performed a single-center, retrospective longitudinal cohort study in 33 consecutive pwAI offered a therapeutic trial of CSHI due to persistent AI symptoms.

Our cohort comprised of 33 pwAI (82% women). Nine (27.3%) had primary adrenal insufficiency, 16 (48.5%) had secondary AI, and 8 (24.2%) had glucocorticoid-induced AI. The median total daily dose of glucocorticoid (in hydrocortisone equivalent) decreased from 30 mg/d (range, 15-180 mg) before CSHI to 26.7 mg/d (P = .013) at CSHI initiation and 26.6 mg/d (P = .023) at last encounter. The median number of ED visits/year due to adrenal crisis decreased from 0.5 (range, 0-3.4) to 0 (P = .002) and median number of hospitalization days/y decreased from 0.2 (range, 0-18) to 0 (P = .019) after switching to CSHI. There was a numerical increase in subjective health scores (SF-36 survey) following CSHI use. No significant differences were noted for change in weight, blood pressure, diabetes, cardiovascular/cerebrovascular events, total cholesterol, LDL, and/or triglyceride concentrations pre and post CSHI. At study conclusion, most patients (84.8%) remained on CSHI based on personal preference and tolerability.

CSHI is a safe and effective means of delivering individualized glucocorticoid therapy to pwAI.