Dual-release hydrocortisone improves body composition and the glucometabolic profile in patients with secondary adrenal insufficiency

Nanna Thurmann Jørgensen, Victor Brun Boesen, Stina Willemoes Borresen, Thea Christoffersen, Niklas Rye Jørgensen, Peter Plomgaard, Christina Christoffersen, Torquil Watt, Ulla Feldt-Rasmussen, Marianne Klose*

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

1 Citationer (Scopus)
7 Downloads (Pure)

Abstract

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.
OriginalsprogEngelsk
TidsskriftEndocrine
Vol/bind84
Udgave nummer3
Sider (fra-til)1182-1192
Antal sider11
ISSN1355-008X
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
This work is supported by grants from the Skibsreder Per Henriksen, R. & Hustrus Fund, Eva Maduras Foundation, Novo Nordisk Foundation as part of a collaborative grant (NNF20OC0063280), the Foundation of Merchant L.F. Foght (LFF 22.143), and Shire International GmbH (IST-DNK-000718), a member of the Takeda group of companies. Ulla Feldt-Rasmussen’s research salary was funded by Kristen and Freddy Johansen’s Fund. Marianne Klose’s research salary was sponsored by Skibsreder Per Henriksen, R. & Hustrus Fund. Open access funding provided by National Hospital.

Publisher Copyright:
© The Author(s) 2024.

Citationsformater