TY - JOUR
T1 - Dual-release hydrocortisone improves body composition and the glucometabolic profile in patients with secondary adrenal insufficiency
AU - Jørgensen, Nanna Thurmann
AU - Boesen, Victor Brun
AU - Borresen, Stina Willemoes
AU - Christoffersen, Thea
AU - Jørgensen, Niklas Rye
AU - Plomgaard, Peter
AU - Christoffersen, Christina
AU - Watt, Torquil
AU - Feldt-Rasmussen, Ulla
AU - Klose, Marianne
N1 - © 2024. The Author(s).
PY - 2024/6
Y1 - 2024/6
N2 - 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.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.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 A1c (HbA1c), and 24-hour blood pressure.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), HbA1c (-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.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.CLINICAL TRIAL REGISTRATION: EudraCT201400203932.
AB - 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.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.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 A1c (HbA1c), and 24-hour blood pressure.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), HbA1c (-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.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.CLINICAL TRIAL REGISTRATION: EudraCT201400203932.
KW - Adrenal insufficiency
KW - Body composition
KW - Diurnal cortisol secretion
KW - Dual-release hydrocortisone
KW - Glucose metabolism
KW - Glycated Hemoglobin/analysis
KW - Prospective Studies
KW - Humans
KW - Middle Aged
KW - Cortisone/administration & dosage
KW - Male
KW - Treatment Outcome
KW - Body Composition/drug effects
KW - Hydrocortisone/blood
KW - Saliva/chemistry
KW - Blood Glucose/drug effects
KW - Blood Pressure/drug effects
KW - Adrenal Insufficiency/drug therapy
KW - Adult
KW - Female
KW - Aged
KW - Delayed-Action Preparations
UR - http://www.scopus.com/inward/record.url?scp=85184868515&partnerID=8YFLogxK
U2 - 10.1007/s12020-024-03711-9
DO - 10.1007/s12020-024-03711-9
M3 - Journal article
C2 - 38345683
SN - 1355-008X
VL - 84
SP - 1182
EP - 1192
JO - Endocrine
JF - Endocrine
IS - 3
ER -