Continuous Subcutaneous Hydrocortisone Infusion in Adrenal Insufficiency: Practical Experience in 33 Subjects.

Continuous subcutaneous hydrocortisone infusion reduced the median total daily dose of glucocorticoid in hydrocortisone equivalent.

• Median total daily dose decreased from 30 mg/d (range, 15-180 mg) before CSHI to 26.7 mg/d at CSHI initiation (P = .013) and 26.6 mg/d at last encounter (P = .023).
• The cohort comprised 33 consecutive people with adrenal insufficiency (pwAI) in a single-center, retrospective longitudinal cohort study.
• 82% of the cohort were women; 27.3% had primary AI, 48.5% had secondary AI, and 24.2% had glucocorticoid-induced AI.
• All patients were offered CSHI due to persistent AI symptoms on conventional therapy.

CSHI significantly reduced emergency department visits due to adrenal crisis.

• Median number of ED visits per year due to adrenal crisis decreased from 0.5 (range, 0-3.4) to 0 after switching to CSHI (P = .002).
• This finding was based on a retrospective longitudinal cohort of 33 subjects.
• The reduction represents a statistically significant improvement in acute adrenal crisis events.

CSHI significantly reduced the number of hospitalization days per year.

• Median number of hospitalization days per year decreased from 0.2 (range, 0-18) to 0 after switching to CSHI (P = .019).
• This reduction was observed across all subtypes of adrenal insufficiency included in the cohort.
• The finding was part of a retrospective longitudinal cohort analysis at a single center.

There was a numerical increase in subjective health scores following CSHI use as measured by the SF-36 survey.

• The paper reports 'a numerical increase in subjective health scores (SF-36 survey) following CSHI use.'
• No specific p-value or magnitude of change for SF-36 scores was reported in the abstract, suggesting the increase was not statistically significant.
• SF-36 was used as the patient-reported outcome measure for subjective health status.

CSHI had no significant effect on cardiometabolic parameters.

• No significant differences were noted for change in weight, blood pressure, diabetes, cardiovascular/cerebrovascular events, total cholesterol, LDL, and/or triglyceride concentrations pre and post CSHI.
• This finding suggests CSHI does not worsen cardiometabolic risk factors compared to conventional therapy.
• The analysis was conducted within the same retrospective cohort of 33 subjects.

The majority of patients remained on CSHI at study conclusion based on personal preference and tolerability.

• 84.8% of patients remained on CSHI at study conclusion.
• Continuation was attributed to personal preference and tolerability.
• This high continuation rate is from a cohort of 33 consecutive pwAI offered a therapeutic trial of CSHI.

Conventional glucocorticoid replacement therapy in adrenal insufficiency is associated with diminished subjective health status and increased mortality.

• This is cited as established background context motivating the study of CSHI.
• CSHI permits individualized glucocorticoid delivery and 'mimics a more physiologic cortisol pattern compared with oral glucocorticoid therapy.'
• The authors note that 'data are limited regarding patient selection for CSHI, optimal dosing of CSHI, and CSHI impact on relevant clinical outcomes.'