title: Impaired subjective health status in chronic adrenal insufficiency: impact of different glucocorticoid replacement regimens.
abstract: BACKGROUND
  Recent studies have suggested that current glucocorticoid replacement therapies fail to fully restore well-being in patients with adrenal insufficiency (AI).
  
  
  OBJECTIVE
  To investigate the effect of different glucocorticoid preparations used for replacement therapy on subjective health status (SHS) in AI.
  
  
  METHODS
  In a cross-sectional study, primary and secondary AI patients were contacted by mail. Individual glucocorticoid replacement regimens, underlying diagnoses and comorbidities were verified by questionnaires and review of medical records. Patients were asked to complete three validated self-assessment questionnaires (Short Form 36 (SF-36), Giessen Complaint List (GBB-24), and Hospital Anxiety and Depression Scale). Results were compared with sex- and age-matched controls drawn from the questionnaire-specific reference cohort.
  
  
  RESULTS
  Of the 883 patients identified, 526 agreed to participate in the study. Completed questionnaire sets were available from 427 patients (primary AI n=232; secondary AI n=195). AI patients showed significantly impaired SHS compared with controls irrespective of the glucocorticoid used for replacement. The only difference in SHS between patients on prednisolone (PR) and hydrocortisone (all patients and sub-analysis for primary AI) was significant higher bodily pain (lower Z-score in SF-36) in patients on PR (P<0.05, P<0.01 respectively). In patients with secondary AI, the PR group showed significantly (P<0.05) less heart complaints (lower Z-score) in the GBB questionnaire compared with the cortisone acetate group.
  
  
  CONCLUSIONS
  Glucocorticoid replacement therapy with PR seems to be equivalent to hydrocortisone regarding SHS in patients with AI. However, SHS remains impaired in all patient groups suggesting a need for further improved glucocorticoid replacement strategies.
authors.affiliation: Clinical Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, Charitéplatz 1, D 10117 Berlin, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bleicken
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hahner
authors.forename: Melanie
authors.initials: M
authors.lastname: Loeffler
authors.forename: Manfred
authors.initials: M
authors.lastname: Ventz
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
mesh_terms: D000224:Addison Disease / Q000188:drug therapy* / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D005938:Glucocorticoids