Increase in HDL-C, Adiponectin Levels With Glucocorticoid Replacement Therapy

Glucocorticoid replacement therapy is associated with an increase in serum levels of adiponectin and high-density lipoprotein cholesterol.

Glucocorticoid replacement therapy is associated with an increase in serum levels of adiponectin and high-density lipoprotein cholesterol (HDL-C), according to study results published in The Journal of Clinical Endocrinology & Metabolism.

There is limited information regarding the association between glucocorticoid replacement therapy in patients with secondary adrenal insufficiency (SAI) and levels of serum adiponectin. As for HDL-C levels, previous studies have reported that short-term glucocorticoid therapy is associated with increased HDL-C levels in healthy patients and patients with SAI, but no information is available regarding the association between lipid profile and intrinsic adrenal function.

To better understand these associations, researchers conducted a two-part study: the first part was a cross-sectional study that focused on 58 patients (34 men; median age, 55 years) with nonfunctional pituitary adenoma, aiming to assess the effects of intrinsic adrenal function on serum adiponectin and lipid profile. All patients underwent an insulin tolerance test to assess adrenal function.

The second part was a randomized double-blind crossover study that included 12 patients (4 men; median age, 58 years) with SAI receiving hydrocortisone replacement. The study consisted of 3 terms (4 weeks each) in which patients were randomly assigned to receive hydrocortisone therapy at a dose of either 10, 20, or 30 mg daily. The goal was to assess the effects of this treatment on serum adiponectin levels in patients with SAI.

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Results from the first part of the study indicated a significant correlation between peak cortisol levels with serum HDL-C levels (R, 0.46; P <.01) and serum adiponectin levels after the insulin tolerance test (R, 0.46; P <.05), while basal cortisol levels were only significantly correlated with HDL-C levels (R, 0.37; P <.01).

Comparing patients with SAI (n=29) to patients without SAI (n=29) after the insulin tolerance test, serum adiponectin levels tended to be lower (5.6 vs 6.7 µg/mL; P =.11) and HDL-C levels were significantly lower (44 vs 52 mg/dL; P <.05) in the SAI group.

In the second part of the study, the data suggested a dose-dependent increase in serum adiponectin levels with hydrocortisone treatment (8.3±1.1 µg/mL with 10 mg/d; 8.6±1.1 µg/mL with 20 mg/d; 10.3±1.1 µg/mL with 30 mg/d). In a similar fashion, HDL-C levels increased in a dose-dependent manner in patients with SAI receiving hydrocortisone (55±4.0 mg/dL with 10 mg/d; 62±4.0 mg/dL with 20 mg/d; and 73±4.0 mg/dL with 30 mg/d).

“[W]e have demonstrated in the present study that glucocorticoid replacement therapy using a high-dose schedule within the clinical replacement range, increased serum levels of adiponectin, an adipose-derived anti-atherogenic factor, as well as HDL-C levels in a dose-dependent manner in [patients with SAI],” concluded the researchers.

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Hayashi R, Tamada D, Murata M, et al. Glucocorticoid replacement affects serum adiponectin levels and HDL-C in patients with secondary adrenal insufficiency [published online July 10, 2019]. J Clin Endocrinol Metab. doi:10.1210/jc.2019-00420