Extract

We read with great interest the article titled ‘Cardiometabolic and psychological effects of dual-release hydrocortisone: a cross-over study’ by Dineen et al. (1) and also discussed it in our clinical endocrinology postgraduate program. The ideal replacement steroid for adrenal insufficiency (including both primary and secondary insufficiency) is long overdue, and this study would certainly benefit in this context. The study evaluated the impact of shifting to dual-release hydrocortisone (DR-HC) replacement from the conventional steroid replacement in adrenal insufficiency over a period of 12 weeks on various metabolic and quality of life parameters.

An interesting finding noted in the study was a greater reduction of blood pressure (BP) in the secondary adrenal insufficiency (SAI) group as compared to the primary adrenal insufficiency (PAI) group (reduction in systolic BP: −5.7 mmHg, P = 0.0019 and diastolic BP: –4.5 mmHg, P = 0.0011 within the entire study population (n = 51)). This observation was seen despite a similar 20 mg dose of DR-HC received by both groups. This finding is in contrast to previous randomized controlled trials, which showed a significant decrease in BP among PAI patients after treatment with DR-HC (2).

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