Quality of Life in Patients with Addison's Disease:

Abstract

This study compares the impact of different modes of cortisol replacement therapy on the health perception and general well-being in patients with primary adrenocortical failure. 14 adults (8 female, 6 male) with Addison's disease on chronic cortisol replacement participated in the study. In a randomized double-blind cross-over design, all patients were treated with 3 modes of cortisol replacement for one week each (mode I: 20 mg hydrocortisone (HC) at 0700 h and 10 mg HC at 1900 h; mode II: 30 mg HC at 0700 h and placebo at 1900 h; mode III: placebo at 0700 h and 30 mg HC at 1900 h). Following the third week, the replacement modes were repeated in a different random order. For quality-of-life assessment the patients completed three different questionnaires (Addison-questionnaire, Basler Befindlichkeits-Skala, Beschwerde-Liste) and were interviewed about their general contentment at the last day of each treatment week. General well-being in terms of subjective contentment was best established during mode I (in 64% of patients) and less often stated with mode II (in 29%) and III (in 14%) (p < 0.05 mode I vs III). With the twice-daily replacement (mode I), sum scores of all questionnaires were changed towards improvement compared to both once-daily regimens (p < 0.05 vs mode II and III), but did not reach normal values of healthy subjects. Differences between mode II and III were insignificant. We conclude that quality of life in Addison patients is mainly influenced by the mode of cortisol replacement therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychological morbidity and impaired quality of life in patients with stable treatment for primary adrenal insufficiency: cross-sectional study and review of the literature

“…In addition, Association between hydrocortisone dosage and identity problems. (11,37,39,40). Accordingly, we found negative effects of high hydrocortisone intake on QoL in patients with PAI.…”

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

“…Other studies investigated less physiological HC regimes, suggesting an advantage of imitating the circadian rhythm of cortisol secretion (10,11). Experimental crossover studies offer the advantage to control for interindividual variation as each patient is treated with different replacement regimens and is hence his or her own control.…”

Results of the Prolonged Use of Subcutaneous Continuous Infusion of Hydrocortisone in a Man with Congenital Adrenal Hyperplasia

“…A decreased quality of life in patients with Addison's disease or CAH is well known [12]. The influence of the mode of the hydrocortisone replacement has been noted [13]. Thus, SCIH therapy capable of mimicking the natural circadian cortisol production seems to be the best hydrocortisone delivery mode enhancing quality of life.…”