Adrenocortical function in patients with Single Large Scale Mitochondrial DNA Deletions: a retrospective single centre cohort study

Author:

Siri Barbara12ORCID,D’Alessandro Annamaria3,Maiorana Arianna1,Porzio Ottavia3,Ravà Lucilla4ORCID,Dionisi-Vici Carlo1,Cappa Marco5,Martinelli Diego1

Affiliation:

1. Division of Metabolic Diseases and Hepatology, Bambino Gesù Children’s Hospital, IRCCS , 00165 Rome , Italy

2. Department of Paediatrics, Città della Salute e della Scienza, OIRM, University of Turin , 10126 Turin , Italy

3. Clinical Biochemistry Laboratory, Bambino Gesù Children’s Hospital, IRCCS , 00165 Rome , Italy

4. Clinical Epidemiology Unit, Bambino Gesù Children’s Hospital, IRCCS , 00165 Rome , Italy

5. Research Area of Innovative Therapies in Endocrinopathies, Bambino Gesù Children’s Hospital, IRCCS , 00165 Rome , Italy

Abstract

Abstract Objective Single Large Scale Mitochondrial DNA Deletions (SLSMDs), Pearson Syndrome (PS) and Kearns-Sayre Syndrome (KSS), are systemic diseases with multiple endocrine abnormalities. The adrenocortical function has not been systematically investigated with a few anecdotal reports of overt adrenal insufficiency (AI). The study aimed to assess the adrenocortical function in a large cohort of SLSMDs. Design and methods A retrospective monocentric longitudinal study involved a cohort of 18 SLSMDs patients. Adrenocortical function was evaluated by baseline adrenocorticotrophic hormone (ACTH) and cortisol measurements and by high- (HDT) and low-dose (LDT) ACTH stimulation tests and compared with 92 healthy controls (HC). Results Baseline adrenocortical function was impaired in 39% of patients and by the end of the study, 66% of PS and 25% of KSS showed an insufficient increase after ACTH stimulation, with cortisol deficiency due to primary AI in most PS and subclinical AI in KSS. Symptomatic AI was recorded in 44% of patients. Peak cortisol levels after ACTH stimulation tests were significantly lower in patients than in HC (P < .0001), with a more reduced response to LDT vs HDT (P < .05). Conclusions Our study highlights that cortisol deficiency due to primary AI represents a relevant part of the clinical spectrum in SLSMDs, with more severe impairment in PS than in KSS. Basal and after-stimulus assessment of adrenocortical axis should be early and regularly investigated to identify any degree of adrenocortical dysfunction. The study allowed the elaboration of a diagnostic process designed for the diagnosis, treatment, and follow-up of adrenocortical abnormalities in SLSMDs.

Funder

Italian Ministry of Health

Publisher

Oxford University Press (OUP)

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism

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