Visceral adiposity index and metabolic profile in adult patients with congenital adrenal hyperplasia: hydrocortisone versus prednisone treatment.

Background: Patients with Congenital Adrenal Hypeplasia (CAH) due to 21-hydroxylase deficiency need a life-long therapy with glucocorticoids (GCs) and tend to have a cluster of metabolic risk factors, which are consistent with metabolic syndrome (MS). Most frequently used GCs are Hydrocortisone (HC) and Prednisone (P), different for both pharmacodynamic and pharmacokynetic characteristics. Aim: The aim of this study was to evaluate the impact of HC and P on VAI, a new indicator of visceral fat function, and on metabolic profile in CAH patients long term treated with GC. Materials and Methods: Thirty-two patients (22 F, 10 M, 18-46 yrs), among which 16 (11 F, 5 M) treated with HC (dose 10-45…

Treatment of skeletal impairment in patients with endogenous hypercortisolism: when and how?

Guidelines for the management of osteoporosis induced by endogenous hypercortisolism are not available. Both the American College of Rheumatology and the International Osteoporosis Foundation recommend to modulate the treatment of exogenous glucocorticoid-induced osteoporosis (GIO) based on the individual fracture risk profile (calculated by FRAX) and dose of glucocorticoid used, but it is difficult to translate corticosteroid dosages to different degrees of endogenous hypercortisolism, and there are no data on validation of FRAX stratification method in patients with endogenous hypercortisolism. Consequently, it is unclear whether such recommendations may be adapted to patients with endoge…

EFFECT OF SWITCH FROM CONVENTIONAL GLUCOCORTICOIDS TO “DUAL RELEASE HYDROCORTISONE” (DR-HC) ON METABOLIC PROFILE AND QUALITY OF LIFE IN ADULT PATIENTS WITH SECONDARY ADRENAL INSUFFICIENCY (SAI): RESULTS OF THREE MONTHS FOLLOW-UP

The hypertension of Cushing's syndrome: Controversies in the pathophysiology and focus on cardiovascular complications

Cushing's syndrome is associated with increased mortality, mainly due to cardiovascular complications, which are sustained by the common development of systemic arterial hypertension and metabolic syndrome, which partially persist after the disease remission. Cardiovascular diseases and hypertension associated with endogenous hypercortisolism reveal underexplored peculiarities. The use of exogenous corticosteroids also impacts on hypertension and cardiovascular system, especially after prolonged treatment. The mechanisms involved in the development of hypertension differ, whether glucocorticoid excess is acute or chronic, and the source endogenous or exogenous, introducing inconsistencies a…