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Irish Journal of Medical Science (1971 -)

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Open Access 13-08-2021 | Glucocorticoid | Brief Report

Poor quality of life and sleep in patients with adrenal insufficiency—another cause of increased mortality?

Authors: Antje K. Blacha, Peter Kropp, Amir H. Rahvar, Jörg Flitsch, Iris van de Loo, Birgit Harbeck

Published in: Irish Journal of Medical Science (1971 -) | Issue 4/2022

Abstract

Background

Patients with adrenal insufficiency (AI) are treated with glucocorticoid replacement therapy (GRT). Although current glucocorticoid regimens aim to mimic the physiological circadian rhythm of cortisol secretion, temporary phases of hypo- and hypercortisolism are common undesired effects which lead to a variety of consequences like increased cardiovascular risk and premature mortality. Additionally, poor quality of life (QoL) and impaired sleep have been reported. However, little is known about these topics regarding the effects of daily dosage, duration of therapy, and patients with different forms of AI (primary, PAI, and secondary, SAI).

Methods

In this study, 40 adults with AI substituted with hydrocortisone (HC) and 20 matched healthy controls completed questionnaires evaluating depressive symptoms, subjective health status, quality of sleep and daytime sleepiness. Furthermore, demographic data, dosage of HC, duration of therapy and co-medication were evaluated. Patients were compared in different groups.

Results

Patients assessed general health significantly worse than controls; likewise, daytime sleepiness was reported significantly more often. Depressive symptoms differed significantly in the two groups but did not reach clinically relevant scores. There was no difference between patients with PAI and SAI. High dosage of hydrocortisone had negative impact on mental health but not on sleep quality or daytime sleepiness.

Conclusions

The present data highlight that poor QoL and impaired sleep are still severe and underrated issues in current GRT and might be additional factors for premature mortality in patients with AI. Some AI patients reach normal or near-normal self-assessed QoL and sleep, even despite unphysiological replacement.

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Title: Poor quality of life and sleep in patients with adrenal insufficiency—another cause of increased mortality?
Authors: Antje K. Blacha
Peter Kropp
Amir H. Rahvar
Jörg Flitsch
Iris van de Loo
Birgit Harbeck
Publication date: 13-08-2021
Publisher: Springer International Publishing
Keyword: Glucocorticoid
Published in: Irish Journal of Medical Science (1971 -) / Issue 4/2022
Print ISSN: 0021-1265
Electronic ISSN: 1863-4362
DOI: https://doi.org/10.1007/s11845-021-02731-y

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