Patients with Addison's disease show no increase in adipose tissue

Although patients with Addison’s disease who were treated with glucocorticoids demonstrated increased cortisol exposure, they did not have increased levels of visceral abdominal adipose tissue compared with healthy controls, study data showed.

However, researchers reported that patients with Addison’s disease had a higher prevalence of metabolic syndrome and exhibited several biomarkers for cardiovascular disease.

“In the 1960s, studies suggested that only undiagnosed patients [with Addison’s disease] and patients living under poor social circumstances were at increased risk of death, whereas for patients receiving good clinical surveillance the expectation of life should not be shortened,” Ragnhildur Bergthorsdottir, MD, PhD, of the department of endocrinology at Sahlgrenska University Hospital, Gothenburg, Sweden, and colleagues wrote. “More recent studies have, however, shown a more than two-fold increased mortality, in some studies mainly due to cardiovascular disease, but also due to malignancies, infections and sudden death.”

The researchers performed a cross-sectional, single-center case-control study of 76 patients with Addison’s disease who were matched one-to-one with healthy controls by age, sex, smoking habits and BMI. The main outcome was visceral abdominal adipose tissue, while the secondary outcomes were prevalence of biomarkers for CVD and metabolic syndrome.

The patients were mostly women (n = 51), and the mean age was 53 years. Mean BMI was 25 kg/m², and mean duration of Addison’s disease was 17 years. Patients received a median daily hydrocortisone dose of 30 mg.

Compared with controls, patients with Addison’s disease demonstrated increased 24-hour urinary free cortisol excretion (359 nmol vs. 175 nmol; P < .001), Bergthorsdottir and colleagues reported. However, the two groups did not show a significant difference in visceral abdominal adipose tissue (76 cm² in patients vs. 71 cm² in controls).

Seventeen of 92 CV biomarkers in the study showed significant differences in patients compared with controls, the researchers reported, with patients showing increased inflammatory, pro-inflammatory and pro-atherogenic risk biomarkers, as well as decreased vasodilatory protective marker. Thirty-four percent (n = 26) of patients with Addison’s disease met the criteria for metabolic syndrome, compared with 16% (n = 12) of controls (P = .01).

“Our findings may be explained by the non-physiological [hydrocortisone] replacement dose regime that in turn may translate into excess mortality from cardiovascular diseases,” Bergthorsdottir and colleagues wrote. – by Andy Polhamus

Disclosures: Bergthorsdottir reports no relevant financial disclosures. Please see the study for a complete list of all other authors’ relevant financial disclosures.