Hasenmajer Valeria, De Alcubierre Dario, Ferrari Davide, Minnetti Marianna, Bonaventura Ilaria, Pofi Riccardo, Simeoli Chiara, Tomaselli Alessandra, Sciarra Francesca, Bottillo Grazia, Angelini Francesco, Cozzolino Alessia, Venneri Mary Anna, Jannini Emmanuele A, Gianfrilli Daniele, Pivonello Rosario, Isidori Andrea M
Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy.
Inserm U1052, CNRS UMR5286, Cancer Research Center of Lyon, Claude Bernard Lyon 1 University, Lyon, France.
Andrology. 2025 Feb;13(2):302-313. doi: 10.1111/andr.13635. Epub 2024 Mar 28.
Data on sexual function in patients with adrenal insufficiency are scarce and largely controversial.
To investigate sexual dysfunction in patients with primary and secondary adrenal insufficiency and the effects of switching to once-daily dual-release hydrocortisone on sexual function in outcome assessors blinded, randomized, multicenter, active comparator clinical trial.
Eighty-nine adrenal insufficiency patients on conventional, multiple daily doses of glucocorticoid replacement, enrolled in the Dual RElease hydrocortisone versus conventionAl glucocorticoid replaceMent in hypocortisolism (DREAM) trial, were randomly assigned to continue their therapy or to switch to an equivalent dose of dual-release hydrocortisone. Sixty-three patients (34 women) consented to sex steroid measurements and questionnaires completion for quality of life (Addison's disease-specific quality-of-life questionnaire) and sexual function evaluation (female sexual function index for women, International Index of Erectile Function-Erectile Function for men) at baseline and 24 weeks after randomization.
At baseline, sexual dysfunction was observed in 41% of women and 59% of men with adrenal insufficiency. In both sexes, no associations were found between sexual function and hormone levels, whereas Addison's disease-specific quality-of-life questionnaire total and fatigue domain scores positively correlated with total female sexual function index and International Index of Erectile Function-Erectile Function scores. At 24 weeks, there was no significant difference either in sexual function or sex steroid levels between study groups. In the dual-release hydrocortisone group, the variation in the female sexual function index desire domain score was positively associated with the change in Addison's disease-specific quality-of-life questionnaire's symptom domain score (ρ = 0.478, p = 0.045).
Sexual dysfunction is common in adrenal insufficiency patients and is likely explained by multiple factors. dual-release hydrocortisone treatment is not directly associated with sexual function improvement, but an indirect effect mediated by quality-of-life amelioration cannot be excluded.
肾上腺功能不全患者性功能方面的数据稀缺且存在很大争议。
在一项评估者盲法、随机、多中心、活性对照临床试验中，研究原发性和继发性肾上腺功能不全患者的性功能障碍以及改用每日一次的双释放氢化可的松对性功能的影响。
89名接受常规每日多次剂量糖皮质激素替代治疗的肾上腺功能不全患者参加了氢化可的松双释放与传统糖皮质激素替代治疗肾上腺皮质功能减退症（DREAM）试验，被随机分配继续原治疗或改用等效剂量的双释放氢化可的松。63名患者（34名女性）同意在基线和随机分组后24周进行性类固醇测量，并完成生活质量问卷（艾迪生病特异性生活质量问卷）和性功能评估（女性用女性性功能指数，男性用国际勃起功能指数-勃起功能）。
基线时，41%的肾上腺功能不全女性和59%的男性存在性功能障碍。在两性中，性功能与激素水平之间均未发现关联，而艾迪生病特异性生活质量问卷总分及疲劳领域得分与女性性功能指数总分及国际勃起功能指数-勃起功能得分呈正相关。24周时，研究组之间性功能或性类固醇水平均无显著差异。在双释放氢化可的松组中，女性性功能指数欲望领域得分的变化与艾迪生病特异性生活质量问卷症状领域得分的变化呈正相关（ρ = 0.478，p = 0.045）。
性功能障碍在肾上腺功能不全患者中很常见，可能由多种因素导致。双释放氢化可的松治疗与性功能改善无直接关联，但不能排除生活质量改善介导的间接效应。
