Exploring sexual function in adrenal insufficiency: findings from the Dual RElease hydrocortisone versus conventionAl glucocorticoid replaceMent therapy in hypocortisolism (DREAM) trial.

Sexual dysfunction was prevalent in both women and men with adrenal insufficiency at baseline.

• Sexual dysfunction was observed in 41% of women and 59% of men with adrenal insufficiency at baseline.
• 63 patients (34 women) consented to sex steroid measurements and questionnaire completion.
• Sexual function was assessed using the Female Sexual Function Index (FSFI) for women and the International Index of Erectile Function-Erectile Function (IIEF-EF) for men.

No associations were found between sexual function and hormone levels in either sex.

• In both sexes, no associations were found between sexual function scores and sex steroid hormone levels at baseline.
• Sex steroid measurements were obtained alongside questionnaire completion at baseline and at 24 weeks after randomization.

Quality of life scores positively correlated with sexual function scores in both sexes.

• Addison's disease-specific quality-of-life questionnaire (AddiQoL) total and fatigue domain scores positively correlated with total FSFI and IIEF-EF scores.
• This association was observed in both women and men with adrenal insufficiency.
• The correlation suggests that quality of life, rather than hormone levels, may be a key mediator of sexual function in this population.

Switching to dual-release hydrocortisone did not produce a significant difference in sexual function or sex steroid levels compared to conventional therapy at 24 weeks.

• At 24 weeks, there was no significant difference either in sexual function or sex steroid levels between the dual-release hydrocortisone group and the conventional glucocorticoid replacement group.
• 89 adrenal insufficiency patients on conventional multiple daily doses of glucocorticoid replacement were randomly assigned to continue their therapy or switch to an equivalent dose of dual-release hydrocortisone.
• The trial was an outcome assessors blinded, randomized, multicenter, active comparator clinical trial (DREAM trial).
• Patients included those with both primary and secondary adrenal insufficiency.

In the dual-release hydrocortisone group, improvement in sexual desire was positively associated with improvement in disease-specific symptom scores.

• In the dual-release hydrocortisone group, the variation in the FSFI desire domain score was positively associated with the change in AddiQoL symptom domain score (ρ = 0.478, p = 0.045).
• This association suggests a potential indirect effect of dual-release hydrocortisone on sexual function mediated through quality-of-life improvement.
• This finding was specific to the dual-release hydrocortisone treatment group and was not reported for the conventional therapy group.

The study population included patients with both primary and secondary adrenal insufficiency enrolled in the DREAM trial.

• 89 adrenal insufficiency patients on conventional, multiple daily doses of glucocorticoid replacement were enrolled.
• 63 patients (34 women) consented to sex steroid measurements and questionnaire completion for quality of life and sexual function evaluation.
• Assessments were conducted at baseline and 24 weeks after randomization.
• The DREAM trial was a randomized, multicenter, active comparator clinical trial with outcome assessors blinded to treatment allocation.