Tissue Glucocorticoid Metabolism in Adrenal Insufficiency: A Prospective Study of Dual-release Hydrocortisone Therapy
Authors' conclusion
Using comprehensive in vivo techniques, we have demonstrated abnormalities in corticosteroid metabolism in patients with primary and secondary AI receiving IR-HC. This dysregulation of pre-receptor glucocorticoid metabolism results in enhanced glucocorticoid activation in adipose tissue, which was ameliorated by treatment with DR-HC.
Study context
- Population
- Patients with primary and secondary adrenal insufficiency (AI) on glucocorticoid (GC) replacement
- Participants
- 51 patients
- Exposure
- Dual-release hydrocortisone (DR-HC) vs immediate release hydrocortisone (IR-HC) in AI; AI on IR-HC vs healthy controls
- Outcome
- Median 24-hour urinary cortisol excretion, AI on IR-HC vs healthy controls
Methodological detailsage- and BMI-matched controls
- Age- and BMI-matched controls
Main finding
As reported in the abstract
P = 0.02
Observational data: associations, not effects.
Further findings
Switch from IR-HC to DR-HC · 12 weeks
- Significant reduction in urinary cortisol and total GC metabolite excretion, most significant in the evening
- Increase in 11β-HSD2 activity
- Hepatic 11β-HSD1 activity not significantly altered
- Significant reduction in expression and activity of 11β-HSD1 in subcutaneous adipose tissue
Original publication
Tissue Glucocorticoid Metabolism in Adrenal Insufficiency: A Prospective Study of Dual-release Hydrocortisone Therapy. J Clin Endocrinol Metab. Published 20 June 2023. doi:10.
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