Metabolic and cardiovascular profile in patients with Addison's disease under conventional glucocorticoid replacement

• Published in: Journal of endocrinological investigation Vol. 32; no. 11; p. 917
• Main Authors: Giordano, R, Marzotti, S, Balbo, M, Romagnoli, S, Marinazzo, E, Berardelli, R, Migliaretti, G, Benso, A, Falorni, A, Ghigo, E, Arvat, E
• Format: Journal Article
• Language: English
• Published: Italy 01.12.2009
• Subjects: Addison Disease - complications; Addison Disease - drug therapy; Addison Disease - metabolism; Addison Disease - physiopathology; Adrenocorticotropic Hormone - blood; Adult; Aged; Blood Glucose - metabolism; Body Mass Index; Cardiovascular Diseases - etiology; Cardiovascular Diseases - physiopathology; Dehydroepiandrosterone Sulfate - blood; Female; Glucocorticoids - therapeutic use; Humans; Lipids - blood; Male; Middle Aged; Renin - blood; Waist Circumference
• ISSN: 1720-8386; 1720-8386
• DOI: 10.3275/6437

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. 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). 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. Our study shows a higher prevalence of central adiposity, impaired glucose tolerance and dyslipidemia in AD patients.