title: Influence of hydrocortisone dosage scheme on health-related quality of life in patients with adrenal insufficiency.
abstract: BACKGROUND
  Recent studies suggest that current glucocorticoid replacement therapies fail to completely restore well-being in patients with adrenal insufficiency (AI).
  
  
  OBJECTIVE
  The objective of this study was to investigate health-related quality of life (QoL) in patients with AI depending on dose and frequency of daily intake of hydrocortisone (HC).
  
  
  METHODS
  In a cross-sectional study, primary and secondary AI patients were contacted and asked to complete three validated self-assessment questionnaires [Short Form-36 (SF-36), Giessen Complaint List (GBB-24), Hospital Anxiety and Depression Scale (HADS)]. HC doses were corrected for body surface area. Results were compared with sex- and age-matched controls drawn from the questionnaire-specific reference cohort.
  
  
  RESULTS
  Completed questionnaire sets were available from 334 patients on HC (primary AI n = 194; secondary AI n = 140). Patients on higher doses of HC (>30 mg/day) showed significantly impaired subjective health status in two of eight SF-36 dimensions, and three of five GBB-24 scales compared with those on lower HC doses. No significant differences in QoL were found between lower HC doses (15-30 mg/day) or between primary or secondary AI. Patients on HC with thrice daily intake showed significantly impaired QoL in one of eight SF-36 dimensions (15-20 mg/day, 20-25 mg/day), in one of five GBB-24 scales (15-20 mg/day), as well as higher anxiety scores.
  
  
  CONCLUSIONS
  Health-related QoL was impaired in patients with primary and secondary AI. HC doses above 30 mg/day were associated with a worse health status. Thrice daily intake of HC was not superior to twice daily intake. Our data support the perception that current replacement strategies are still insufficient to fully restore well-being and daily performance.
authors.affiliation: Clinical Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, 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: Oliver
authors.initials: O
authors.lastname: Decker
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 / Q000523:psychology; D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000523:psychology; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone