The effects of two different doses of hydrocortisone on cognition in patients with secondary adrenal insufficiency - Results from a randomized controlled trial

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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

18 Citations (Scopus)

Abstract

Context: A wide variety in hydrocortisone (HC) substitution dose-regimens are considered physiological for patients with secondary adrenal insufficiency (SAD. However, it is likely that cognition is negatively influenced by higher cortisol exposure to the brain.

Objective: To examine the effects of a high physiological HC dose in comparison to a low physiological HC dose on cognition.

Design and setting: This study was a randomized double blind cross-over study at the University Medical Center Groningen. This study is registered with ClinicalTrials.gov, number NCT01546922.

Patients: Forty-seven patients (29 males, 18 females; mean [SD] age, 51 [14] years, range 19-73) with SAI participated.

Intervention(s): Patients randomly received first a low dose of HC (0.2-0.3 mg/kg body weight/day) during 10 weeks followed by a high dose (0.4-0.6 mg/kg body weight/day) for another 10 weeks, or vice versa. HC substitution was given in three divided doses with the highest dose in the morning.

Main outcome measure(s): Cognitive performance (memory, attention, executive functioning and social cognition) of patients was measured at baseline and after each treatment period using a battery of 12 standardized cognitive tests.

Results: The higher dose of HC resulted in significantly higher systemic cortisol exposure for example measured at 1 h after first dose ingestion (mean [SD], low dose: 653 [281] nmol/L; high dose: 930 [148] nmol/L; P

Conclusions: No negative influence on memory, attention, executive functioning and social cognition was observed after 10 weeks of treatment with a higher physiological dose of HC in patients with SAI when compared to a lower dose. (C) 2015 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)36-47
Number of pages12
JournalPsychoneuroendocrinology
Volume55
DOIs
Publication statusPublished - May-2015

Keywords

  • Cognition
  • Hydrocortisone
  • Secondary adrenal insufficiency
  • QUALITY-OF-LIFE
  • GLUCOCORTICOID REPLACEMENT
  • DECLARATIVE MEMORY
  • CORTISOL-LEVELS
  • HYPOPITUITARY PATIENTS
  • SOCIAL COGNITION
  • SERUM CORTISOL
  • DOUBLE-BLIND
  • STRESS
  • CORTICOSTEROIDS

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