Journal Article

Somatosensory function in patients with secondary adrenal insufficiency treated with two different doses of hydrocortisone—Results from a randomized controlled trial

Brummelman, Pauline, Wolffenbuttel, Bruce H. R., van Beek, André P., Werumeus Buning, Jorien, Konopka, Karl-Heinz, van der Klauw, Melanie M., Tucha, Oliver, Koerts, Janneke, Dullaart, Robin P. F., van den Berg, Gerrit

2017

Overview

Low cortisol levels are associated with several functional pain syndromes. In patients with secondary adrenal insufficiency (SAI), the lack in endogenous cortisol production is substituted by the administration of oral hydrocortisone (HC). Our previous study showed that a lower dose of HC led to an increase in reported subjective pain symptoms. Whether different doses of HC substitution alter somatosensory functioning in SAI patients has not been established yet. In this randomized double blind cross-over trial, forty-six patients with SAI participated. Patients randomly received either first a lower dose (0.2-0.3 mg HC/kg body weight/day) for 10 weeks followed by a higher dose (0.4-0.6 mg HC/kg body weight/day) for another 10 weeks, or vice versa. After each treatment period, blood samples were drawn and somatosensory functioning was assessed by determining the mechanical detection threshold (MDT), mechanical pain threshold (MPT), mechanical pain sensitivity (MPS) and the pain pressure threshold (PPT), according to the Quantitative Sensory Testing (QST) battery by the German Network on Neuropathic Pain. The administration of the higher dose of HC resulted in significantly higher levels of cortisol (mean [SD] 748 [245] nmol/L) than the lower dose (537 [250] nmol/L, P<0.001). No differences were found in MDT, MPT, MPS and PPT z-scores between the two doses of HC. Furthermore, the number of patients showing sensory abnormalities did not differ between the two different doses. The results suggest that the dose of HC has no impact on somatosensory functioning in response to mechanical stimuli in patients with SAI, despite previously found altered subjective pain reports.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Abnormalities / Administration, Oral / Adrenal glands / Adrenal insufficiency / Adrenal Insufficiency - blood / Adrenal Insufficiency - drug therapy / Adrenal Insufficiency - physiopathology / Adult / Anti-Inflammatory Agents - therapeutic use / Biology and Life Sciences / Blood pressure / Body weight / Cross-Over Studies / Diabetes / Disorders / Dosage and administration / Double-Blind Method / Drug Administration Schedule / Drug dosages / Drug therapy / Endocrinology / Feedback / Female / Fibromyalgia / Homeostasis / Hormone Replacement Therapy - methods / Hormones / Humans / Hydrocortisone / Hydrocortisone - therapeutic use / Male / Mechanical stimuli / Medicine and Health Sciences / Middle Aged / Neuralgia / Neuralgia - blood / Neuralgia - physiopathology / Neuralgia - psychology / Neuropathy / Neuropsychology / Pain / Pain Measurement / Pain sensitivity / Pain Threshold - psychology / Patients / Randomization / Sensory testing / Social Sciences / Somatosensory system / Steroids / Substance abuse treatment / Tempering