Department of Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.
Endocrine. 2024 Jun;84(3):1182-1192. doi: 10.1007/s12020-024-03711-9. Epub 2024 Feb 12.
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.
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.
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 A (HbA), and 24-hour blood pressure.
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), HbA (-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.
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.
EudraCT201400203932.
研究表明，与传统氢化可的松（C-HC）相比，接受双重释放氢化可的松（DR-HC）治疗的肾上腺功能不全患者的代谢谱得到改善。本研究调查了与 C-HC 治疗相比，DR-HC 治疗对 5 个健康变量的影响：日间唾液皮质醇/皮质酮、身体成分、骨健康、葡萄糖代谢、脂质和血压。
对 27 名（24 名男性）继发性肾上腺功能不全患者进行前瞻性研究，在稳定的 C-HC 治疗期间和治疗转换为 DR-HC 后 16 周进行测量。
在切换到 DR-HC 后，日间唾液皮质醇 AUC 非显著下降（平均差异：-55.9 nmol/L/天，P=0.06）。唾液皮质酮 AUC 不变。深夜唾液皮质醇和皮质酮较低（-1.6 和-1.7 nmol/L，P=0.002 和 0.004）。总脂肪和腹部脂肪量（-1.5 和-0.5 公斤，P=0.003 和 0.02）、HbA（-1.2 mmol/mol，P=0.02）和骨钙素降低（-7.0 µg/L，P=0.03），而 Sclerostin 增加（+41.1 pg/mL，P=0.0001）。其余骨状态指标、脂质和血压保持不变。
本研究表明，切换到 DR-HC 可导致更低的深夜皮质醇/皮质酮暴露，以及更有利的代谢谱和身体成分。相比之下，骨钙素的减少和 Sclerostin 的增加可能表明对骨骼产生负面影响。
EudraCT201400203932。
