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Dual-release hydrocortisone and its benefits on cognitive function and quality of sleep

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Abstract

Purpose

Patients with adrenal insufficiency are usually treated with conventional hydrocortisone replacement therapy which fails to mimic the circadian rhythm of cortisol secretion. Dual-release hydrocortisone (DR-HC) resembles the daily normal cortisol profile improving metabolic parameters and quality of life. However, currently little is known about its impact on cognitive function. Aim of this study was to evaluate cognitive function and well-being in DR-HC treated patients compared to healthy controls and conventional HC treatment.

Methods

Twenty adults with adrenal insufficiency treated with DR-HC (Plenadren®) underwent 10 neuropsychological tests, evaluating cognitive functions. Furthermore, demographic data, quality of life, symptoms of depression, and quality of sleep were evaluated by well-established questionnaires. Patients were compared by diagnosis (PAI/SAI) and dose (≥20 mg). In addition, eighteen DR-HC treated adults were compared to eighteen matched conventionally treated adults.

Results

With respect to diagnosis patients with PAI performed significantly better on intellectual abilities (p = 0.038) and on executive functioning (p = 0.026) and reported a significant longer time to fall asleep (p = 0.026). Regarding DR-HC dosage, there were no significant differences in cognitive functions. Patients on high dose reported a better subjective quality of sleep (p = 0.028) than patients on low dose. In comparison to conventional HC treatment, patients with DR-HC tended to show better results in executive functioning (p = 0.099).

Conclusion

Patients with PAI reached better results in several cognitive functions and had a worse quality of sleep than patients with SAI. Our data suggest a positive impact of DR-HC on quality of sleep. DR-HC may be better for executive functioning.

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Author contributions

C.K.: Data collection, Data analysis/interpretation, Drafting Article, Statistics; P.K.: Data analysis/Interpretation; A.K.B.: Data analysis/Interpretation; A.H.R.: Critical revision of article; B.H.: Concept/design, Approval of article

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Authors and Affiliations

  1. Department of Medicine I, University of Luebeck, Luebeck, Germany

    Clarissa Krekeler, Antje Katrin Blacha & Birgit Harbeck

  2. Institute of Medical Psychology and Medical Sociology, University of Rostock, Rostock, Germany

    Peter Kropp

  3. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Amir-Hossein Rahvar

  4. MVZ Amedes Experts, Endocrinology, Hamburg, Germany

    Birgit Harbeck

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  1. Clarissa Krekeler
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  2. Peter Kropp
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Correspondence to Birgit Harbeck.

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The study protocol was approved by the Ethics Committee of the University of Luebeck, Germany (AZ 17-135).

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Krekeler, C., Kropp, P., Blacha, A.K. et al. Dual-release hydrocortisone and its benefits on cognitive function and quality of sleep. Endocrine 72, 223–233 (2021). https://doi.org/10.1007/s12020-020-02552-6

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  • DOI: https://doi.org/10.1007/s12020-020-02552-6

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