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The metabolic effects of glucocorticoid replacement therapy in patients with secondary adrenal insufficiency due to hypothalamic-pituitary diseases: results from a retrospective and longitudinal study
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DOI：10.1007/s11102-026-01726-1.png)
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Abstract
En 中文
Secondary adrenal insufficiency (SAI) is a complex endocrine disorder. Glucocorticoid (GC) replacement therapy is crucial for ensuring patient survival and guaranteeing an adequate quality of life. GC replacement therapy requires a balance between undertreatment, with the consequent risk of adrenal crisis, and overtreatment, which can have long-term effects on the metabolic and cardiovascular systems. We conducted a retrospective, longitudinal, observational study on 140 patients affected by pituitary disease with at least 3 years of follow-up. Patients were consecutively included in the study with a ratio 1:1, considering patients affected by SAI and who were therefore on GCs replacement therapy, and patients with pituitary disease without SAI (controls). Worsening of glucose metabolism occurred in 29 patients with SAI (64.4%) and in 16 controls (35.6%, p = 0.019). Worsening of lipid metabolism occurred in 52 patients with SAI (56.5%) and in 40 controls (43.5% p = 0.033). GC replacement therapy (p = 0.014, OR: 2.3, 95%IC: 1.1–4.9), higher fasting glycaemia at baseline (p = 0.04, OR: 7.6, 95%IC: 2.3–25.4), IGT/T2DM at baseline (p = 0.016, OR: 8.6, 95%IC: 0.8–57) were the main risk factors for the worsening of glucose metabolism at 3-year follow-up. TSH deficit remained the only risk factor for the worsening of lipid profile (p < 0.001, OR: 2.9, 95%IC: 1.3–6.5). Our study proved that GCs replacement therapy may be associated with a worsening of glucose metabolism, particularly in patients already affected by IGT/T2DM. Tailored and holistic management is essential for the management of GCs replacement therapy, in patients with other metabolic disorders and pituitary hormone deficits.
Keywords:
Central adrenal insufficiency
Secondary adrenal insufficiency
Pituitary disease
Hypothalamic disease
Glucocorticoid replacement therapy
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