Sandooja Rashi, Saini Jasmine, Ferreira Taveras Elio, Gregg-Garcia Raul, Zhang Catherine D, Fell Vanessa, Peersen Anina, Achenbach Sara J, Atkinson Elizabeth J, Van Gompel Jamie J, Young William F, Bancos Irina
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55905, United States.
Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Nebraska Medical Center, Omaha, NE 68198, United States.
Eur J Endocrinol. 2025 Apr 30;192(5):621-630. doi: 10.1093/ejendo/lvaf092.
Glucocorticoid withdrawal syndrome (GWS) may develop in patients following successful surgery for endogenous hypercortisolism. Effective strategies to minimize GWS and improve quality of life (QoL) are currently lacking. We aimed to determine the impact of hydrocortisone vs prednisone therapy on GWS and QoL during the first 12 weeks postsurgery.
Single-center prospective cohort study (2019-2024) of adults with endogenous hypercortisolism who developed postoperative adrenal insufficiency and treated with either prednisone or hydrocortisone. Quality of life was assessed with Short Form-36 (SF-36) and Cushing QoL questionnaires at baseline and at 12 weeks postsurgery. GWS was assessed using weekly AddiQoL questionnaires for the first 12 weeks postsurgery.
Of 165 patients, 101 (61%) were treated with hydrocortisone and 64 (39%) with prednisone. At baseline, no group differences were found in the hypercortisolism subtype, comorbidities, or QoL assessments. At follow-up, no group differences in final total daily hydrocortisone equivalent dose were seen.When adjusting for the baseline QoL assessment, patients treated with prednisone demonstrated a higher degree of improvement in their QoL, particularly in the SF-36 mental component score (estimate 0.33, 95% CI, 0.04-0.63), SF-36 role-emotional limitation (estimate 0.52, 95% CI, 0.2-0.84), and SF-36 body pain (estimate 0.31, 95% CI, 0.07-0.56) subcomponents. In the multivariable analysis of age, sex, body mass index, glucocorticoid type, baseline clinical severity score, and baseline QoL assessment, prednisone therapy was an independent predictor of better SF-36 mental component at 12 weeks postsurgery.
Prednisone therapy was associated with better mental health QoL than hydrocortisone at 12 weeks postsurgery in patients with hypercortisolism.
内源性皮质醇增多症患者成功手术后可能会出现糖皮质激素撤药综合征（GWS）。目前缺乏将GWS降至最低并改善生活质量（QoL）的有效策略。我们旨在确定氢化可的松与泼尼松治疗对术后12周内GWS和QoL的影响。
对患有内源性皮质醇增多症且术后出现肾上腺功能不全并接受泼尼松或氢化可的松治疗的成年人进行单中心前瞻性队列研究（2019 - 2024年）。在基线和术后12周时，使用简明健康状况调查量表（SF - 36）和库欣生活质量问卷评估生活质量。在术后的前12周，使用每周一次的AddiQoL问卷评估GWS。
165例患者中，101例（61%）接受氢化可的松治疗，64例（39%）接受泼尼松治疗。在基线时，高皮质醇血症亚型、合并症或生活质量评估方面未发现组间差异。在随访时，最终每日氢化可的松等效总剂量方面未观察到组间差异。在对基线生活质量评估进行调整后，接受泼尼松治疗的患者在生活质量方面有更高程度的改善，特别是在SF - 36心理成分得分（估计值0.33，95%可信区间，0.04 - 0.63）、SF - 36角色情感限制（估计值0.52，95%可信区间，0.2 - 0.84）和SF - 36身体疼痛（估计值0.31，95%可信区间，0.07 - 0.56）子成分方面。在对年龄、性别、体重指数、糖皮质激素类型、基线临床严重程度评分和基线生活质量评估进行多变量分析时，泼尼松治疗是术后12周时SF - 36心理成分改善更好的独立预测因素。
在皮质醇增多症患者术后12周时，泼尼松治疗与比氢化可的松更好的心理健康生活质量相关。
