Cortisol Curve after Hydrocortisone Loading – an Effective Tool for Optimization of Replacement Therapy in Adrenal Insufficiency

Presentation Number: SAT 400
Date of Presentation: April 1st, 2017

Merav Serebro1, Ohad Bentur2, Yael Sofer1, Etty Osher3, Naftali Stern3 and Yona Greenman*3
1Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, 2Tel Aviv-Sourasky Medical Center, 3Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Abstract

Background: Titration of glucocorticoid replacement therapy in adrenal insufficiency is mostly based on clinical assessment, due to the lack of precise laboratory tools for treatment monitoring. Overdosing might lead to increased morbidity including hypertension, weight gain, diabetes and osteoporosis whereas underdosing may result in life threatening adrenal crises. We examined the efficacy of cortisol curves as an objective tool for dose titration.

Methods: Retrospective review of hydrocortisone loading curves performed in adrenal insufficient patients between 2008 and 2015 in our institute. Serum cortisol levels were measured prior and 30, 60, 120, 180, 240 and 300 minutes following administration of the patient`s regular morning hydrocortisone dose. Dose adjustments were performed by the treating physician based on cortisol profile results. Metabolic data, including weight, blood pressure and lipid profile were documented before and after performance of the curve.

Results: Sixty five hydrocortisone loading curves were performed in 51 patients during the study period. Pertinent clinical data was available for 28 patients. Mean age 44.8±13.7 years, 43% males, average weight was 82.9±21.9kg, 36% were hypertensive and 25% had diabetes. Mean daily hydrocortisone dose was 23.1±7.3 mg. Based on cortisol curve results, the dose was decreased in 54% of patients, unchanged in 36% and increased in 11%. There were no statistically significant between-group differences in age, sex, starting dose, starting weight, diabetes and hypertension prevalence. The average dose change was -8.2mg in the dose reduction group and +1.5mg in the rest of the study population (p<0.05). The average change in blood pressure was -11.38/-9.13 in the dose reduction group as compared to +0.8/+2.9 in the rest of the study population (p<0.05). A statistically non-significant reduction in weight, LDL and total cholesterol levels was also noted in the dose reduction group.

Discussion: Our findings suggest that cortisol curves are an effective tool for hydrocortisone dose titration, leading to a significant reduction in blood pressure in this cohort.

 

Nothing to Disclose: MS, OB, YS, EO, NS, YG