How hydrocortisone substitution influences the quality of life and the bone metabolism of patients with secondary hypocortisolism

Background Even in the setting of chronic glucocorticoid substitution in hy pocortisolaemic patients, severe side-effects will eventually occur when th e dosage is inappropriately high. This study evaluates the effect of usual hydrocortisone substitution dosages on the well-being of the patients and o n parameters of the bone metabolism to establish an optimum substitution do sage. Design In a double blind study nine patients with secondary hypocortisolism , bring divided in three groups of three, received different doages of hydr ocortisone (15, 20, 30 mg per day). Well-being was assessed using three dif ferent, validated questionnaires. Markers of bone metabolism were measured in blood and urine. Results The patients' quality of life was not impaired even at low dosages of hydrocortisone (15 or 20 mg per day). Of all laboratory parameters only osteocalcin significantly changed, decreasing at higher dosages. Conclusions Our study shows that a risk of bone loss may be avoided with a substitution dosage of 20 mg or even 15 mg hydrocortisone per day, without influencing the well-being of the patient.