Patients with adrenal insufficiency have cardiovascular features associated with hypovolemia.

ABSTRACT: CONTEXT:Patients with adrenal insufficiency (AI) have excess mortality and morbidity, mainly due to cardiovascular (CV) diseases. The mechanisms for this is unclear. OBJECTIVE:To assess CV structure and function in AI patients on conventional replacement therapy and after switching to once-daily, modified-release hydrocortisone (OD-HC) in comparison with healthy matched controls. METHODS:This was a retrospective analysis of 17 adult AI patients (11 with primary AI, 6 with secondary AI) on stable replacement with cortisone acetate [median (minimum, maximum) 33.5 (12.5-50)?mg] and, if needed, fludrocortisone [0.1 (0.05-0.2)?mg], and 17 healthy matched controls. Ten patients were switched to an equivalent dose of OD-HC. Data from echocardiography, 24?h Holter-ECG and 24?h blood pressure monitoring were collected at baseline and 6 months after the switch to OD-HC. RESULTS:At baseline, AI patients had smaller left ventricular diastolic diameter (47.1?±?4.2 vs. 51.6?±?2.3?mm; P?=?0.001) and left atrial diameter (34.9?±?4.7 vs. 38.2?±?2.6?cm; P?=?0.018), and a higher ejection fraction (62.5?±?6.9% vs. 56.0?±?4.7%; P?=?0.003) than controls. AI patients had lower nocturnal systolic and diastolic blood pressure than controls (108?±?15?mmHg vs. 117?±?8?mmHg; P?=?0.038 and 65?±?9?mmHg vs. 73?±?7?mmHg; P?=?0.008, respectively). After the switch to OD-HC, nocturnal diastolic blood pressure normalised. No significant changes were observed in echocardiographic and Holter-ECG parameters following the switch. CONCLUSIONS:AI patients on conventional treatment display cardiovascular abnormalities that could be related to hypovolemia. Switch to OD-HC seems to have beneficial effect on blood pressure profile, but no effect on cardiovascular structure and function.

SUBMITTER: Esposito D 

PROVIDER: S-EPMC7581570 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature