Correction of cortisol overreplacement ameliorates morbidities in patients with hypopituitarism: a pilot study.
BACKGROUND
Hypopituitarism in adults is known to be associated with deleterious effects on body composition, lipid profile and quality of life (QoL). This was attributed to GH deficiency. The potential role of glucocorticoid overreplacement had never been investigated.


OBJECTIVE
To investigate whether reduction in glucocorticoid replacement dose to more physiological one could ameliorate the "AO-GHD"-attributed symptomatology in patients with hypopituitarism. Design Eleven patients with panhypopituitarism taking 20-30 mg/day of hydrocortisone, but on no GH replacement were switched to 10-15 mg of hydrocortisone daily. Both basally and 6-12 months later, their body mass index, body composition by dual-energy X-ray absorptiometry, lipid profile, and the score of quality of life, QOL-AGHDA were measured.


RESULTS
Within 6-12 months of lower hydrocortisone dose, subjects lost an average of 7.1 kg of total body fat and 4.1 kg of abdominal fat. No changes were seen in lean body mass, bone mineral content and HOMA-IR. Plasma total cholesterol and triglyceride concentrations decreased significantly (< 0.05) and the QoL improved (P = 0.018).


CONCLUSIONS
Our pilot study suggests that decreasing the glucocorticoid replacement dose to approximately 15 mg/day is beneficial in terms of patients' body composition, lipid profile and quality of life.
Danilowicz
Karina
K
Division of Endocrinology, Hospital de Clínicas, Avenida Córdoba 2351, 5 degrees piso, 1120, Ciudad Autónoma de Buenos Aires, Argentina. kdanilowicz@hotmail.com
Bruno
Oscar Domingo
OD
Manavela
Marcos
M
Gomez
Reynaldo Manuel
RM
Barkan
Ariel
A
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D001823:Body Composition / Q000187:drug effects; D015992:Body Mass Index; D003480:Cushing Syndrome / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D019382:Human Growth Hormone / Q000172:deficiency; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000009:adverse effects; D007018:Hypopituitarism / Q000188:drug therapy* / Q000378:metabolism; D050356:Lipid Metabolism / Q000187:drug effects; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D005938:Glucocorticoids; D008055:Lipids; D019382:Human Growth Hormone; D006854:Hydrocortisone