Long-term DHEA replacement in primary adrenal insufficiency: A randomized, controlled trial

Autor: Catherine L. Conway, V. Krishna K. Chatterjee, Eleanor M. Gurnell, Eleanor Pullenayegum, Joe Herbert, Penelope J. Hunt, Suzanne Curran, Juliet E. Compston, Felicia A. Huppert
Jazyk: angličtina
Rok vydání: 2008
Předmět:
Male
Endocrinology
Diabetes and Metabolism
Clinical Biochemistry
addison's disease
Biochemistry
Primary Adrenal Insufficiency
Endocrinology
Sex hormone-binding globulin
Absorptiometry
Photon
Cognition
dehydroepiandrosterone
Addison Disease
Bone Density
Surveys and Questionnaires
cognitive ability
polycyclic compounds
Medicine
Prospective Studies
skin and connective tissue diseases
Testosterone
biology
Dehydroepiandrosterone Sulfate
mental processes
Middle Aged
Addison's disease
Female
Original Article
hormones
hormone substitutes
and hormone antagonists
Adult
medicine.medical_specialty
endocrine system
medicine.drug_class
Hormone Replacement Therapy
Dehydroepiandrosterone
Statistics
Nonparametric
Double-Blind Method
Internal medicine
Adrenal insufficiency
Humans
Aged
personal satisfaction
body composition
business.industry
Biochemistry (medical)
medicine.disease
Mineralocorticoid
biology.protein
Lean body mass
Quality of Life
fatigue
business
human activities
Popis: Context: Dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS) are the major circulating adrenal steroids and substrates for peripheral sex hormone biosynthesis. In Addison’s disease, glucocorticoid and mineralocorticoid deficiencies require lifelong replacement, but the associated near-total failure of DHEA synthesis is not typically corrected. Objective and Design: In a double-blind trial, we randomized 106 subjects (44 males, 62 females) with Addison’s disease to receive either 50 mg daily of micronized DHEA or placebo orally for 12 months to evaluate its longer-term effects on bone mineral density, body composition, and cognitive function together with well-being and fatigue. Results: Circulating DHEAS and androstenedione rose significantly in both sexes, with testosterone increasing to low normal levels only in females. DHEA reversed ongoing loss of bone mineral density at the femoral neck (P < 0.05) but not at other sites; DHEA enhanced total body (P = 0.02) and truncal (P = 0.017) lean mass significantly with no change in fat mass. At baseline, subscales of psychological well-being in questionnaires (Short Form-36, General Health Questionnaire-30), were significantly worse in Addison’s patients vs. control populations (P < 0.001), and one subscale of SF-36 improved significantly (P = 0.004) after DHEA treatment. There was no significant benefit of DHEA treatment on fatigue or cognitive or sexual function. Supraphysiological DHEAS levels were achieved in some older females who experienced mild androgenic side effects. Conclusion: Although further long-term studies of DHEA therapy, with dosage adjustment, are desirable, our results support some beneficial effects of prolonged DHEA treatment in Addison’s disease.
Databáze: OpenAIRE
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