Patients with adrenal insufficiency have cardiovascular features associated with hypovolemia

Abstract

Context Patients with adrenal insufficiency (AI) have excess mortality and morbidity, mainly due to cardiovascular (CV) diseases. The mechanisms for this is unclear. Objective To assess CV structure and function in AI patients on conventional replacement therapy and after switching to once-daily, modified-release hydrocortisone (OD-HC) in comparison with healthy matched controls. Methods This was a retrospective analysis of 17 adult AI patients (11 with primary AI, 6 with secondary AI) on stable replacement with cortisone acetate [median (minimum, maximum) 33.5 (12.5–50) mg] and, if needed, fludrocortisone [0.1 (0.05–0.2) mg], and 17 healthy matched controls. Ten patients were switched to an equivalent dose of OD-HC. Data from echocardiography, 24 h Holter-ECG and 24 h blood pressure monitoring were collected at baseline and 6 months after the switch to OD-HC. Results At baseline, AI patients had smaller left ventricular diastolic diameter (47.1 ± 4.2 vs. 51.6 ± 2.3 mm; P = 0.001) and left atrial diameter (34.9 ± 4.7 vs. 38.2 ± 2.6 cm; P = 0.018), and a higher ejection fraction (62.5 ± 6.9% vs. 56.0 ± 4.7%; P = 0.003) than controls. AI patients had lower nocturnal systolic and diastolic blood pressure than controls (108 ± 15 mmHg vs. 117 ± 8 mmHg; P = 0.038 and 65 ± 9 mmHg vs. 73 ± 7 mmHg; P = 0.008, respectively). After the switch to OD-HC, nocturnal diastolic blood pressure normalised. No significant changes were observed in echocardiographic and Holter-ECG parameters following the switch. Conclusions AI patients on conventional treatment display cardiovascular abnormalities that could be related to hypovolemia. Switch to OD-HC seems to have beneficial effect on blood pressure profile, but no effect on cardiovascular structure and function.

Coronary artery disease in a patient with Addison’s disease: a case report and literature review

“…Over doses of glucocorticoids increase the risk of cardiovascular disease, but little is known about the relationship between glucocorticoid insufficiency and cardiovascular disease. The reasons for the progression of CAD due to Addison’s disease may be as following: (1) Esposito et al show that patients with adrenal insufficiency often have low blood volume and low blood pressure [ 9 , 10 ]. When combined with coronary artery stenosis, insufficient coronary blood supply would further aggravates myocardial ischemia; (2) Cortisol insufficiency is accompanied by increased levels of inflammatory cytokine such as TNF-α, IL-1, and IL-6 [ 11 ], which are closely related to the occurrence of cardiovascular events [ 11 , 12 ]; (3) Cortisol insufficiency is also related to disorders of glucose and lipid metabolism.…”

The use of prednisolone versus dual-release hydrocortisone in the treatment of hypoadrenalism

“…The effects of Plenadren on blood pressure are difficult to interpret. Ten patients out of 17, stably replaced with cortisone acetate and diagnosed with adrenal insufficiency, were converted to Plenadren in a retrospective, case-control analysis ( 46 ). When patients were treated with Plenadren for 6 months, nocturnal diastolic pressure rose by 9 mmHg.…”