Hydrocortisone dose in adrenal insufficiency: Balancing harms and benefits

Patients with secondary adrenal insufficiency do not produce cortisol and are therefore treated with hydrocortisone tablets. The optimal substitution dose for hydrocortisone is unknown. We therefore performed this study, in which two different doses of hydrocortisone and its effect on cognition (observing, remembering, thinking), quality of life and blood pressure were studied. We further looked at how fast hydrocortisone was removed from the body. Patients received both a lower dose of hydrocortisone and the double amount of it, adjusted to body weight. Both doses were administered for 10 weeks and the order of the doses was random. Total daily doses were divided in three daily administrations. The most important findings of our study were that quality of life improved after treatment with the higher dose of hydrocortisone. Patients reported less symptoms of depression, less fatigue, more vitality and a better general health. They also reported less pain. Cognitive functioning (such as memory, attention and problem solving skills) was not influenced after 10 weeks of treatment with the higher dose of hydrocortisone. Blood pressure did increase after 10 weeks of treatment with the higher dose, but fats in blood such as cholesterol, did not change. Striking was the large difference in the way in which hydrocortisone was removed from the body between patients, which could differ up to 10-fold. This suggests that for some patients, thrice daily dosing is not enough to establish the correct blood level of hydrocortisone.