Somatosensory function in patients with secondary adrenal insufficiency treated with two different doses of hydrocortisone: Results from a randomized controlled trial

Jorien Werumeus Buning*, Karl-Heinz Konopka, Pauline Brummelman, Janneke Koerts, Robin P. F. Dullaart, Gerrit van den Berg, Melanie M. van der Klauw, Oliver Tucha, Bruce H. R. Wolffenbuttel, Andre A. P. van Beek

*Corresponding author for this work

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Abstract

Background: Low cortisol levels are associated with several functional pain syndromes. In patients with secondary adrenal insufficiency (SAI), the lack in endogenous cortisol production is substituted by the administration of oral hydrocortisone (HC). Our previous study showed that a lower dose of HC led to an increase in reported subjective pain symptoms. Whether different doses of HC substitution alter somatosensory functioning in SAI patients has not been established yet.

Methods: In this randomized double blind cross-over trial, forty-six patients with SAI participated. Patients randomly received either first a lower dose (0.2-0.3 mg HC/kg body weight/ day) for 10 weeks followed by a higher dose (0.4-0.6 mg HC/kg body weight/ day) for another 10 weeks, or vice versa. After each treatment period, blood samples were drawn and somatosensory functioning was assessed by determining the mechanical detection threshold (MDT), mechanical pain threshold (MPT), mechanical pain sensitivity (MPS) and the pain pressure threshold (PPT), according to the Quantitative Sensory Testing (QST) battery by the German Network on Neuropathic Pain.

Results: The administration of the higher dose of HC resulted in significantly higher levels of cortisol (mean [SD] 748 [245] nmol/L) than the lower dose (537 [250] nmol/L, P

Conclusions: The results suggest that the dose of HC has no impact on somatosensory functioning in response to mechanical stimuli in patients with SAI, despite previously found altered subjective pain reports.

Original languageEnglish
Article numbere0180326
Number of pages11
JournalPLoS ONE
Volume12
Issue number7
DOIs
Publication statusPublished - 7-Jul-2017

Keywords

  • LOW-BACK-PAIN
  • NEUROPATHIC PAIN
  • AXIS
  • DEXAMETHASONE
  • FIBROMYALGIA
  • PROTOCOL
  • CORTISOL

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