6571 Tracking Emotional Well-being And Hormonal Interactions In Adrenal Insufficiency Through Ecological Momentary Assessment

Disclosure: A. Miya: None. A. Suga: None. Y. Suzuki: None. H. Nomoto: None. H. Kameda: None. A. Nakamura: None. H. Ohira: None. T. Nakamura: None. Y. Ozaki: None. T. Atsumi: None. Background: For people undergoing glucocorticoid replacement, adrenal insufficiency underlies diminished physical function and emotional well-being. When psychological stress escalates, increasing the hormone replacement dosage is required for preventing adrenal failure, but the optimal timing for this adjustment is not clear. Using Ecological Momentary Assessment (EMA) that allows real-time evaluation of momentary emotional states, we investigated the relationship between the emotional states of people with adrenal insufficiency and cortisol levels to seek the early detection of symptoms of adrenal failure. Methods: We conducted surveys on 14 healthy adult males using the EMA smartphone application for two weeks. The surveys were conducted five times a day, including upon waking and before bedtime. The surveys targeted aspects including momentary fatigue, depressive mood, anxiety, positive emotions, and stress in daily life. Cortisol levels were measured from their saliva samples collected upon waking each day. Next, we conducted a pilot study with two adult males with adrenal insufficiency using the same system. Results: In healthy males (average age 53.3 years), 87.3% (856 out of 980) of EMA surveys were completed. Multilevel correlation analysis revealed a significant relationship within individuals between elevated salivary cortisol levels and increased fatigue (p < 0.01). Between individuals, heightened fatigue was significantly related to worsening of the depressive mood, as well as decreased positive emotions (p < 0.05). In a pilot analysis, Case 1, a 72-year-old male with ACTH deficiency, was using hydrocortisone at a dosage of 15mg per day. Case 2, a 68-year-old male with hypopituitarism, was taking hydrocortisone at a dosage of 20mg per day. In both cases, 87.1% (122 out of 140) of EMA surveys were completed. There was no significant correlation between elevated salivary cortisol levels and fatigue. However, the relationship of salivary cortisol levels to depressive mood, to anxiety, and to positive emotions varied among individuals and within each individual as well. Conclusion: Our findings suggest the relationships between fatigue, momentary emotional well-being and salivary cortisol levels appear to differ among people with and without adrenal insufficiency. EMA may be useful for gaining the understanding of daily emotional states, potentially offering a new personalized preventive approach for adrenal insufficiency. Presentation: 6/2/2024