title: Exploring the Impact of Short- and Long-Term Hydrocortisone Replacement on Cognitive Function, Quality of Life and Catecholamine Secretion: A Pilot Study.
abstract: Hydrocortisone (HC) substitution is essential in the treatment for patients with adrenal insufficiency (AI). Current replacement regimens however only incompletely mimic the physiological circadian rhythm of cortisol secretion, thereby resulting in subclinical temporary hypo- and hypercortisolism. Several studies point toward impairment of cognitive functions under these conditions, in part due to affected catecholamine secretion. Aim of this study was to evaluate the influence of long-term versus short-term HC replacement therapy on the adrenomedullary system and cognitive functions. Fourteen patients with primary or secondary AI were divided into two groups, depending on the duration of disease and HC replacement therapy (<15 years). All subjects underwent standardized neurocognitive testing; in addition, cortisol and catecholamine levels as well as physiological parameters and quality of life (QoL) were assessed. Patients with HC replacement therapy ≥15 years (n = 7) received significantly higher equivalent glucocorticoid doses than those with a shorter lasting therapy (n = 7; p = 0.048). Neuropsychological tests, QoL, physiological parameters, and cortisol levels did not differ significantly between both groups. Of note, norepinephrine levels were significantly lower in patients on short-term HC replacement therapy (p = 0.025). However, there were no significant differences in catecholamines with respect to the underlying pathophysiology, gender, or age. Irrespective of the duration of use, male patients scored significantly better for single aspects of QoL, whereas females performed significantly better in the attention test. Overall, we showed that duration of cortisol replacement therapy may have an impact on catecholamine release, but does not seem to affect cognitive functions and QoL.
authors.affiliation: Department of Medicine I, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. birgit.harbeck@uksh.de.
authors.forename: Birgit
authors.initials: B
authors.lastname: Harbeck
authors.affiliation: Department of Medicine I, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Danneberg
authors.affiliation: Department of Medicine I, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
authors.forename: Amir-Hossein
authors.initials: AH
authors.lastname: Rahvar
authors.affiliation: Department of Medicine I, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
authors.forename: Christian S
authors.initials: CS
authors.lastname: Haas
authors.affiliation: Department of Medicine I, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Lehnert
authors.affiliation: Institute of Medical Psychology and Medical Sociology, University of Rostock, Rostock, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kropp
authors.affiliation: Department of Medicine I, Christian-Albrechts-University, Kiel, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Mönig
mesh_terms: D000309:Adrenal Insufficiency / Q000188:drug therapy / Q000523:psychology; D000313:Adrenal Medulla; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002395:Catecholamines / Q000378:metabolism*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010865:Pilot Projects; D011788:Quality of Life
chemical_list: D000893:Anti-Inflammatory Agents; D002395:Catecholamines; D006854:Hydrocortisone
keywords: Adrenal insufficiency; Adrenomedullary system; Cognitive function; Hydrocortisone replacement