Influence of hydrocortisone dosage scheme on health‐related quality of life in patients with adrenal insufficiency

Abstract

SummaryContext Recent studies suggest that current glucocorticoid replacement therapies fail to completely restore well-being in patients with adrenal insufficiency (AI). Objective The objective of this study was to investigate healthrelated quality of life (QoL) in patients with AI depending on dose and frequency of daily intake of hydrocortisone (HC). Design and patients In a cross-sectional study, primary and secondary AI patients were contacted and asked to complete three validated self-assessment questionnaires , Giessen Complaint List (GBB-24), Hospital Anxiety and Depression Scale (HADS)]. HC doses were corrected for body surface area. Results were compared with sex-and age-matched controls drawn from the questionnaire-specific reference cohort. Results Completed questionnaire sets were available from 334 patients on HC (primary AI n = 194; secondary AI n = 140). Patients on higher doses of HC (>30 mg/day) showed significantly impaired subjective health status in two of eight SF-36 dimensions, and three of five GBB-24 scales compared with those on lower HC doses. No significant differences in QoL were found between lower HC doses (15-30 mg/day) or between primary or secondary AI. Patients on HC with thrice daily intake showed significantly impaired QoL in one of eight SF-36 dimensions (15-20 mg/day, 20-25 mg/day), in one of five GBB-24 scales (15-20 mg/day), as well as higher anxiety scores. Conclusions Health-related QoL was impaired in patients with primary and secondary AI. HC doses above 30 mg/day were associated with a worse health status. Thrice daily intake of HC was not superior to twice daily intake. Our data support the perception that current replacement strategies are still insufficient to fully restore well-being and daily performance.

Effects of standard glucocorticoid replacement therapies on subjective well-being: a randomized, double-blind, crossover study in patients with secondary adrenal insufficiency

“…This is consistent with previous observational studies comparing patients with primary AI and SAI to normative control groups (2,7,8,9). One reason for impaired subjective health may be that common replacement regimens are not able to mimic the physiological diurnal pattern of cortisol secretion (1).…”

“…15 vs 20 mg). This is complemented by results of previous cross-sectional studies, which indicated an association between higher HC doses and impaired subjective health status (7,9). Unfortunately, our study design does not allow to clearly differentiate the effects of HC dosage and replacement regimen (i.e.…”

“…Interestingly, physical role functioning (as assessed with the respective SF-36 subscale) was affected by HC replacement regimen in a previous study (9) and our study, suggesting that this area of quality of life may Table 3 Quality of life (SF-36), emotional distress (BSI), and alertness (SSS) in patients with secondary adrenal insufficiency (SAI), patient controls (PC), and healthy controls (HC). Quality of life (SF-36 sum scores), emotional distress (BSI), alertness over the course of the day (Stanford Sleepiness Scale (SSS)), and satisfaction with medication were compared within SAI patients for different replacement regimens (i.e.…”

“…Previous studies found little differences between standard replacement regimens and their effects on subjective health and quality of life (5,6,7,8,9); however, many of these studies were cross-sectional (7,8,9). Other studies investigated less physiological HC regimes, suggesting an advantage of imitating the circadian rhythm of cortisol secretion (10,11).…”

The relationship between glucocorticoid replacement and quality of life in 2737 hypopituitary patients

“…The reason is likely to be multifactorial, with aetiology, previous treatments, severity of the hypopituitarism and inadequate replacement therapy as potential important influencing factors (4,5,6). Patients with primary and secondary adrenal insufficiency (AI) also have impaired QoL (7,8,9). In a recent survey including Higher GC doses are also associated with more severe impairments of subjective health status in patients with AI (7,8).…”