title: An observational study on adrenal insufficiency in a French tertiary centre: Real life versus theory.
abstract: BACKGROUND
  Patients suffering from adrenal insufficiency, whether primary (PAI) or secondary (SAI) have an increased mortality risk and increased morbidity. There are no guidelines on hydrocortisone replacement therapy and little is known on patients' management in current practice. We described patients' profiles and treatment in a tertiary referral centre.
  
  
  METHODS
  Data were collected retrospectively from medical charts. PAI and SAI patients were described and compared.
  
  
  RESULTS
  Two hundred and one patients (79 PAI+122 SAI) were included. They had a mean duration of disease of 11.2years. Main causes of PAI were autoimmune diseases (31%) and adrenalectomy (26%). SAI was caused primarily by pituitary tumors (61%) and irradiation (20%). Mean dose of daily hydrocortisone (HC) was 27.5 and 19.9mg/day in PAI and SAI patients respectively, with a majority of patients dividing the dose into 2 intakes (46.8 and 72.2% in PAI and SAI groups, respectively). SAI patients exhibited more cardiovascular risk factors than PAI patients. The HC daily dose was slightly higher in patients with dyslipidemia (in both PAI and SAI groups) and in those with high blood pressure (in the SAI group only). One third of patients were out of work, due to unemployment, sick leaves, or disability.
  
  
  CONCLUSIONS
  The management of AI is far from standardized, and individual tailorization is difficult with currently available means of treatment. Under- and overdose of hydrocortisone likely leads to complications, and altered quality of life reflected by a high rate of "out of work" patients.
authors.affiliation: Service d'endocrinologie, centre de référence DEFHY, hôpital de la Timone, Aix-Marseille université, rue Saint-Pierre, 13005 Marseille, France. Electronic address: Frederic.castinetti@ap-hm.fr.
authors.forename: Frederic
authors.initials: F
authors.lastname: Castinetti
authors.affiliation: Service d'endocrinologie, centre de référence DEFHY, hôpital de la Timone, Aix-Marseille université, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: Mouna
authors.initials: M
authors.lastname: Sahnoun
authors.affiliation: Service d'endocrinologie, centre de référence DEFHY, hôpital de la Timone, Aix-Marseille université, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: Frederique
authors.initials: F
authors.lastname: Albarel
authors.affiliation: Service d'endocrinologie, centre de référence DEFHY, hôpital de la Timone, Aix-Marseille université, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Morange
authors.affiliation: Service d'endocrinologie, centre de référence DEFHY, hôpital de la Timone, Aix-Marseille université, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: Melanie
authors.initials: M
authors.lastname: Philippon
authors.affiliation: Service d'endocrinologie, centre de référence DEFHY, hôpital de la Timone, Aix-Marseille université, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Conte-Devolx
authors.affiliation: Service d'endocrinologie, centre de référence DEFHY, hôpital de la Timone, Aix-Marseille université, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Brue
mesh_terms: D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000209:etiology; D000315:Adrenalectomy; D000328:Adult; D001327:Autoimmune Diseases; D002318:Cardiovascular Diseases; D005260:Female; D005602:France; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006949:Hyperlipidemias; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D006854:Hydrocortisone
keywords: Dyslipidemia; High blood pressure; Hydrocortisone; Hydrocortisone replacement therapy; Hypertension artérielle; Insuffisance surrénalienne primiare; Insuffisance surrénalienne secondaire; Occupational status; Primary adrenal insufficiency; Secondary adrenal insufficiency