DOI: 10.1530/EJE-15-1187 Printed in Great Britain Published by Bioscientifica Ltd. European Journal of Endocrinology www.eje-online.org © 2016 European Society of Endocrinology 174:6 791–799 L-A Behan and others HC regimens and vascular risk factors European Journal of Endocrinology (2016) 174, 791–799 Low-dose hydrocortisone replacement is associated with improved arterial stiffness index and blood pressure dynamics in severely adrenocorticotrophin-deficient hypopituitary male patients Lucy-Ann Behan 1 , David Carmody 1 , Bairbre Rogers 1 , Mark J Hannon 1 , Colin  Davenport 1 , William Tormey 2,3 , Diarmuid Smith 1 , Christopher J Thompson 1 , Alice Stanton 4 and Amar Agha 1 1 Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin, Ireland, 2 Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland, 3 Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK, and 4 Department of Molecular and Cellular Therapeutics, RCSI Research Institute, Dublin, Ireland Clinical Study Abstract Objective: Increased cardiovascular and cerebrovascular morbidity and mortality in hypopituitary subjects may be linked to inappropriate glucocorticoid exposure; however, the pathophysiology remains unclear. We aimed to examine the effect of three commonly prescribed hydrocortisone (HC) regimens on vascular risk factors. Design: An open crossover study randomising ten hypopituitary men with severe adrenocorticotrophic hormone defciency to three HC dose regimens: dose A (20 mg mane and 10 mg tarde), dose B (10 mg mane and 10 mg tarde) and dose C (10 mg mane and 5 mg tarde). Methods: Following 6 weeks on each regimen, participants underwent 24-h serum cortisol sampling, 24-h ambulatory blood pressure (BP) measurements, calculation of the Ambulatory Arterial Stiffness Index (AASI), oral glucose tolerance testing and fasting serum osteoprotegerin (OPG) sampling. Results: There were no differences in 24-h BP between dose regimens and controls; however, low-dose HC replacement (dose C) was associated with the lowest AASI, indicating a less stiff arterial tree (P < 0.05) compared with the other dose regimens. Loss of the physiologic nocturnal BP dip was more common in higher HC replacement regimens, although only signifcant for dose B compared with dose C (P = 0.03). Twenty per cent of patients had abnormal glucose tolerance, but this was unrelated to dose regimen. OPG correlated strongly with 24-h BP in those on dose A only (r = 0.65, P = 0.04). Conclusion: Currently prescribed HC replacement doses do not result in signifcant differences in absolute BP levels or improvements in insulin sensitivity. However, lower HC doses may result in lower arterial stiffness and a more physiological nocturnal BP dip. Long-term studies are required to confrm these fndings and evaluate their impact on vascular morbidity in this patient group. Correspondence should be addressed to A Agha Email amaragha@beaumont.ie Introduction Adults with hypopituitarism have increased mortality primarily due to cardiovascular and cerebrovascular diseases (1, 2, 3, 4, 5, 6), yet the pathophysiologic cause remains speculative and probably multifactorial. Up to 70% of patients with hypopituitarism have varying degrees of adrenocorticotrophic hormone (ACTH)–cortisol Downloaded from Bioscientifica.com at 06/03/2020 03:24:22PM via free access