Metabolic Effects of Cortisone Acetate vs Hydrocortisone in Patients With Secondary Adrenal Insufficiency

Elise Ekstrand; Daniela Esposito; Oskar Ragnarsson; Jörgen Isgaard; Gudmundur Johannsson

doi:10.1210/jendso/bvaa160

Metabolic Effects of Cortisone Acetate vs Hydrocortisone in Patients With Secondary Adrenal Insufficiency

J Endocr Soc. 2020 Oct 29;4(12):bvaa160. doi: 10.1210/jendso/bvaa160. eCollection 2020 Dec 1.

Authors

Elise Ekstrand^{1

2

3}, Daniela Esposito^{1

2}, Oskar Ragnarsson^{1

2}, Jörgen Isgaard^{1

2}, Gudmundur Johannsson^{1

2}

Affiliations

¹ Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
³ Primary Care Facility Kusten, Ytterby, Sweden.

Abstract

Context: Pharmacokinetic properties of cortisone acetate (CA) and hydrocortisone (HC) differ because CA needs to be converted into cortisol to become active.

Objective: This work analyzed the metabolic consequences of switching CA to an equivalent daily dose of HC in patients with secondary adrenal insufficiency (SAI).

Design: This was a post hoc analysis from a prospective study including individuals with hypopituitarism receiving growth hormone replacement. Data were collected before and after a switch from CA to an equivalent dose of HC (switch group). Two control groups were included: patients continuing CA replacement (CA control group) and adrenal-sufficient hypopituitary patients (AS control group).

Results: The analysis included 229 patients: 105, 31, and 93 in the switch, CA control, and AS control groups, respectively. After the change from CA to HC, increases in mean body weight (1.2 kg; P < .05), waist circumference (2.9 cm; P < .001), body fat measured by dual-energy x-ray absorptiometry (1.3 kg; P < .001), and glycated hemoglobin (0.3%; P < .05) were recorded in the switch group. The increase in mean waist circumference was greater than in the AS control group (0.9 cm; P < .05). Mean body fat increased in the switch group but not in the CA control group (-0.7 kg; P < .05).

Conclusions: A switch from CA to an equivalent dose of HC was associated with a worsened metabolic profile, suggesting that HC has a more powerful metabolic action than CA based on the assumption that 20 mg HC equals 25 mg CA.

Keywords: cortisone acetate; hydrocortisone; metabolic outcome; secondary adrenal insufficiency.