Treatment of adrenal insufficiency with hydrocortisone dual-release formulation: glycometabolic profile and health-related quality of life

Introduction: Treatment of adrenal insufficiency (AI) in the last years has been object of important changes due to the development of a dual-release preparation of hydrocortisone (Plenadren®). Hydrocortisone dual-release therapy contemplates a once-daily tablet that allows more closely mimicking the physiological circadian rhythm cortisol, thus avoiding overexposure. Objective: The aim of the study was to value effects of Plenadren administration on the 24-h urinary free cortisol (UFC), the glycometabolic profile and health-related quality of life of patients with AI. Methods and materials: We enrolled seven adults with secondary AI caused by panhypopituitarism (55.9±3.6 years) and seven adults with primary AI (36±6.2 years). We evaluated BMI, UFC levels, the glycometabolic profile and health-related quality of life (estimated by AddiQol questionnaire) before and 3, 6, 9 and 12 months after Plenadren administration. One patient dropped out the study for personal reasons. Results: All patients, except one, reported a significant improvement of the quality of life after 3 months of treatment, whereas after 1 year everyone reported individual wellness. After 12 months of treatment, all parameters evaluated improved, though not in statistically significantly manner. The parameters for which there was evidence of a greater improvement were total cholesterol, low-density cholesterol and glycosylated hemoglobin levels. Conclusions: The once-daily oral hydrocortisone dual-release therapy is a valid option for the treatment of patients with AI. It allows a good glycometabolic balance in the absence of side effects and improving compliance.