Pulsatile Subcutaneous Pump Benefits Primary Adrenal Insufficiency

Subjective improvements seen in fatigue and mood, although no change seen in facial expression recognition task at week 6

By Elana Gotkine HealthDay Reporter

TUESDAY, Oct. 24, 2023 (HealthDay News) — Administration of a pulsatile subcutaneous pump that replicates cortisol’s circadian and ultradian rhythm can improve fatigue and mood among patients with primary adrenal insufficiency (PAI), according to a study published online Oct. 19 in the Journal of Internal Medicine.

Georgina Russell, B.M., B.Sc., from the University of Bristol in the United Kingdom, and colleagues examined the effect of pump therapy on quality of life, mood, functional neuroimaging, behavioral/cognitive responses, sleep, and metabolism in a six-week randomized, crossover feasibility study. Patients with PAI received usual-dose hydrocortisone administered as pulsed subcutaneous or standard care. The primary outcome of the facial expression recognition task (FERT) was assessed at week 6.

Twenty-two participants were recruited and 21 were analyzed. The researchers found that the pump was well tolerated. There was no change observed in the FERT primary outcome; however, subjective improvements were seen in fatigue and mood. Differential neural processing to emotional cues and visual stimulation was seen with functional magnetic resonance imaging. The left amygdala and insula, key glucocorticoid-sensitive regions involved in emotional ambiguity, were identified in a region-of-interest analysis. This response was confirmed in an FERT post-hoc analysis. Four serious adverse events occurred: three intercurrent illnesses requiring hospitalization (one of three in pump) and one planned procedure (one of one in pump). A small number of expected adverse events occurred.

“Our findings support the administration of hormone therapy that mimics natural physiology, and is one of the first major advances in adrenal insufficiency treatment to date,” joint lead author Stafford Lightman, M.B., B.Chir., Ph.D., also from the University of Bristol, said in a statement.