Mineralocorticoid effects of fludrocortisone and hydrocortisone in primary adrenal insufficiency: EU-AIR patient data.

The study analyzed 670 of 924 patients with PAI in the EU-AIR registry, with a mean age of 46.2 years and a majority being women.

• 670 patients were included in the analysis out of 924 total PAI patients in EU-AIR.
• Mean age was 46.2 years.
• 453 patients (67.6%) were women.
• Patients with congenital adrenal hyperplasia or known hypertension were excluded.
• Data were collected between August 7, 2012, and October 31, 2020, from endocrinology centers in Germany, Italy, the Netherlands, Sweden, and the UK.

Among patients receiving fludrocortisone, the distribution of hydrocortisone-equivalent doses per body surface area varied considerably.

• 350 patients received at least one dose of fludrocortisone.
• 45 patients (12.9%) were receiving hydrocortisone-equivalent doses/BSA of ≤ 10 mg/day/m².
• 170 patients (48.6%) were receiving > 10–15 mg/day/m².
• 133 patients (38.0%) were receiving > 15 mg/day/m².

No clear associations were found between total daily fludrocortisone dose per BSA and hydrocortisone-equivalent dose per BSA.

• The relationship between fludrocortisone and hydrocortisone-equivalent dosing was examined with doses corrected for body surface area.
• Fludrocortisone prescription in PAI appears to be independent of glucocorticoid replacement therapy.
• The analysis included patients treated with immediate-release hydrocortisone (IRHC), modified-release hydrocortisone (MRHC), or cortisone acetate.

No clear associations were found between combined mineralocorticoid potency per BSA and systolic or diastolic blood pressure, or sodium or potassium levels.

• Combined mineralocorticoid potency/BSA was examined in relation to both systolic and diastolic blood pressure.
• Sodium and potassium levels were also examined in relation to combined mineralocorticoid potency/BSA.
• No clear associations were identified for any of these relationships.

Higher systolic blood pressure was observed in patients receiving immediate-release hydrocortisone compared to those receiving modified-release hydrocortisone.

• The comparison was made between IRHC and MRHC treatment groups.
• The difference in systolic blood pressure between groups was attributed potentially to different pharmacokinetic profiles of IRHC and MRHC.
• IRHC and MRHC might differ in mineralocorticoid effect owing to different pharmacokinetic profiles.