Katerina Simunkova1, Nevena Jovanovic2, Espen Rostrup2, Paal Methlie2, Marianne Øksnes2, Roy Miodini Nilsen2, Hanne Hennø2, Mira Tilseth2, Kristin Godang2, Ana Kovac2, Kristian Løvås3, Eystein S Husebye3. 1. Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway katerina.simunkova@uib.no. 2. Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway. 3. Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway Department of Clinical ScienceUniversity of Bergen, N-5021 Bergen, NorwayDepartments of MedicineHeart DiseaseCenter for Clinical Research Haukeland University HospitalBergen, 5021 Bergen, NorwaySection of Specialized EndocrinologyDepartment of Endocrinology, Oslo University Hospital Rikshospitalet, N-0027 Oslo, Norway.
Abstract
OBJECTIVE:Many patients with primary adrenal insufficiency (Addison's disease) take extra doses of glucocorticoids during stressful events, but a benefit has not been demonstrated in controlled trials. Here, we investigated the effects of a pre-exercise hydrocortisone dose on cardiorespiratory, hormonal and metabolic parameters in response to short-term strenuous physical activity. DESIGN: This was a randomized placebo-controlled, two-week cross-over clinical trial. PARTICIPANTS: Ten women with Addison's disease and 10 age-matched healthy females participated in the study. MEASUREMENTS: All women in the study underwent maximal incremental exercise testing. A stress dose of 10 mg hydrocortisone or placebo was given 1 h prior to exercise on two occasions. Blood samples were drawn before, and 0, 15 and 30 min post exercise. Oxygen uptake, maximal aerobic capacity, endocrine and metabolic responses to physical activity, as well as health status by questionnaires were evaluated. RESULTS:Maximal aerobic capacity and duration of exercise were significantly lower in patients than in healthy subjects and did not improve with the treatment. After an extra hydrocortisone dose serum cortisol was significantly higher than in the healthy subjects (P<0.001). Post-exercise glucose and adrenaline levels were significantly lower and free fatty acids insignificantly higher in patients irrespective of stress dose. Stress dosing did not alter other metabolic or hormonal parameters or quality of life after the exercise. CONCLUSIONS: The patients did not benefit from an extra dose of hydrocortisone in short strenuous exercise. Stress dosing may not be justified in this setting. Whether stress dosing is beneficial in other types of physical activity will have to be examined further.
RCT Entities:
OBJECTIVE: Many patients with primary adrenal insufficiency (Addison's disease) take extra doses of glucocorticoids during stressful events, but a benefit has not been demonstrated in controlled trials. Here, we investigated the effects of a pre-exercise hydrocortisone dose on cardiorespiratory, hormonal and metabolic parameters in response to short-term strenuous physical activity. DESIGN: This was a randomized placebo-controlled, two-week cross-over clinical trial. PARTICIPANTS: Ten women with Addison's disease and 10 age-matched healthy females participated in the study. MEASUREMENTS: All women in the study underwent maximal incremental exercise testing. A stress dose of 10 mg hydrocortisone or placebo was given 1 h prior to exercise on two occasions. Blood samples were drawn before, and 0, 15 and 30 min post exercise. Oxygen uptake, maximal aerobic capacity, endocrine and metabolic responses to physical activity, as well as health status by questionnaires were evaluated. RESULTS: Maximal aerobic capacity and duration of exercise were significantly lower in patients than in healthy subjects and did not improve with the treatment. After an extra hydrocortisone dose serum cortisol was significantly higher than in the healthy subjects (P<0.001). Post-exercise glucose and adrenaline levels were significantly lower and free fatty acids insignificantly higher in patients irrespective of stress dose. Stress dosing did not alter other metabolic or hormonal parameters or quality of life after the exercise. CONCLUSIONS: The patients did not benefit from an extra dose of hydrocortisone in short strenuous exercise. Stress dosing may not be justified in this setting. Whether stress dosing is beneficial in other types of physical activity will have to be examined further.