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The role of fludrocortisone in cognition and mood in patients with primary adrenal insufficiency (Addison's disease)

Item Type:Article
Title:The role of fludrocortisone in cognition and mood in patients with primary adrenal insufficiency (Addison's disease)
Creators Name:Schultebraucks, K. and Wingenfeld, K. and Otte, C. and Quinkler, M.
Abstract:BACKGROUND: Primary adrenal insufficiency (AI) requires hormone replacement therapy with fludrocortisone and hydrocortisone stimulating glucocorticoid (GR) and mineralocorticoid receptors (MR). Evidence from animal and human studies shows that MR function is crucial for cognitive function and mood. Regarding patients with AI very little is known about the role of MR in cognitive function and mood. METHODS: Repeated measures within-subject design was used to determine whether cognitive function and mood are related to MR occupation in patients with AI. Intraindividually, patients were examined twice with one week apart: once with fludrocortisone (high MR occupation) and once without fludrocortisone (low MR occupation). All patients kept their stable regimen of hydrocortisone. Assessment of cognitive function included executive function, attention and verbal, visuospatial, and working memory. Additionally, mood and blood pressure were measured. RESULTS: Verbal memory improved significantly during high MR occupation (after fludrocortisone intake) compared to low MR occupation (without fludrocortisone, t(29) = -2.1, p = 0.046). There were trend level differences in the Number-Combination-Test (t(29) = -1.9, p = 0.074) and in the Stroop Interference Task (t(29) = -1.9, p = 0.068). No significant differences in visuospatial and working memory were found. Furthermore, current mood state was better during high MR occupation compared to low MR occupation (t(29) = -2.4, p = 0.023) as was diastolic blood pressure (F(2, 29) = 3.6, p = 0.07). CONCLUSIONS: Cognitive function and mood in patients with AI depend in part on MR occupation. Because the medium effect size indicates a potential clinical significance, further studies should systematically examine which dosages of fludrocortisone are associated with optimal cognitive function and mood in AI patients.
Keywords:Addison's Disease, Cognition, Cortisol, Mineralocorticoid and Glucocorticoid Receptor, Primary Adrenal Insufficiency, Fludrocortisone, Mood, Blood Pressure
Page Range:315-320
Date:May 2016
Official Publication:https://doi.org/10.1159/000438791
PubMed:View item in PubMed

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