Impact of postoperative hydrocortisone replacement dose on health-related quality of life and metabolic parameters in patients with cured Cushing's syndrome: randomized, open-label, controlled trial.

Abstract

Purpose: To evaluate the effect of postoperative hydrocortisone dosing on health-related quality of life (HRQoL), metabolic parameters, and hypothalamic-pituitary-adrenal (HPA) axis recovery in cured Cushing's syndrome (CS).

Methods: This single-centre, randomized, open-label trial included 42 adults with CS and postoperative hypocortisolism randomised to hydrocortisone dose 15 mg/day or 30 mg/day during the first three postoperative months. HRQoL was assessed with e EQ-5D and SF-36 at baseline, at 1 and 3 months, and final follow-up while metabolic parameters were evaluated at baseline and 3 months. Dose effects on metabolic parameters were evaluated using ANCOVA; and HPA axis recovery was assessed using Kaplan-Meier and Cox regression analyses.

Results: No significant between-group differences in HRQoL were observed during the three-month period. EQ-5D visual analogue scale scores improved significantly at the final follow-up in both groups, while SF-36 domain scores showed overall improvement over time. At three months, patients receiving 15 mg/day had lower triglycerides, total cholesterol and, HbA1c levels; after adjustment for baseline values, hydrocortisone dose independently affected triglycerides and total cholesterol. No adrenal crises occurred, and there was no excess of acute intercurrent illness or hospitalization in the lower-dose group. HPA axis recovery occurred in 71% of patients and was not associated with hydrocortisone dose.

Conclusions: In cured CS, 15 mg/day hydrocortisone does not worsen HRQoL and had better metabolic profile. HRQoL improves over time irrespective of dose suggesting no benefit from supraphysiological hydrocortisone replacement after curative surgery.