Abstract
Disclosure: N.G. Alves: None. L.C. Almeida: None. G.M. Perini: None. A.P. Alves Lima: None. A.K. Kamitani: None. A.P. Galvão Paim: None. A.M. Sversut Briante: None. D.P. de Oliveira: None. J. Juliasse: None. V.K. Tsuchiya Sano: None. Introduction and objectives: Adrenal insufficiency is marked by adrenal gland failure, resulting in decreased serum cortisol levels. Its treatment centers on hormone replacement with glucocorticoids, with hydrocortisone being the drug that most closely mimics cortisol. Therefore, this meta-analysis aimed to compare the effect of dual-release hydrocortisone with conventional steroids in treating adrenal insufficiency. Methods: MEDLINE, Cochrane, and Scopus databases were searched for randomized clinical trials, observational studies, and cohort studies assessing the efficacy of dual-release hydrocortisone (DR-HC) compared to conventional steroids (HC) in treating adrenal insufficiency. Literature reviews, systematic reviews, case studies, and periodicals were excluded. Statistical analysis was performed using the Mantel-Haenszel method with 95% confidence intervals (CIs). Heterogeneity among the studies was assessed using the I² statistic. R (version 4.4.2) was used for statistical analysis. Results: A total of 5 studies and 378 patients were evaluated, of whom 197 were treated with dual-release hydrocortisone (DRHC) and 181 were treated with conventional glucocorticoids (hydrocortisone and corticoid acetate). The DRHC dose used in the study ranged from 20 to 40 mg/day, while the control group dose ranged from 12.5 to 62.5 mg/day. There were no differences between groups regarding the lipid profile of the patients: Cholesterol (MD -0.11; 95% CI [-0.32 to 0.1]; P= 0.323780; I²= 40.0%), LDL-c (MD -0.14; 95% CI [-0.52 to 0.24]; P= 0.474861; I²= 86.9%) and HDL-c (MD -0.08; 95% CI [-0.29 to 0.14]; P= 0.478946; I²= 88.3%). We also identified no differences between groups for triglyceride levels (MD -0.0; 95% CI [-0.14 to 0.14]; P= 0.976996; I²= 0.0%). Conversely, the DRHC group had a statistically significant reduction in HbA1c (MD -2.86; 95% CI [-4.63 to -1.08]; P= 0.001601; I²= 70.1%) and body mass index (MD -0.79; 95% CI [-1.60 to -0.03]; P= 0.057859; I²= 0.0%). Finally, in addition to the metabolic aspect, hypertensive patients showed significant improvement in systolic blood pressure (MD -3.98; 95% CI [-7.85 to -0.11]; P= 0.043901; I²= 0.0%) and diastolic blood pressure (MD -3.13; 95% CI [-5.38 to -0.88]; P= 0.006467; I²= 0.0%) with the use of DRHC. Conclusion: Dual-release hydrocortisone (DRHC) demonstrated benefits for reducing HbA1c levels, BMI, and blood pressure. No differences were observed for the lipid profile. These results indicate that DRHC is an effective and promising option in the clinical management of patients with adrenal insufficiency. Presentation: Sunday, July 13, 2025