Introduction: Prednisolone is the standard treatment for most inflammatory conditions. However, it is also used in hormone replacement therapy in adrenal insufficiency (AI) due to historical reasons or due to its longer half-life and once daily application. Recent data showed that 5 mg daily prednisolone promotes loss in bone mineral density compared to 20 mg of hydrocortisone in patients with AI questioning the 4:1 conversion rate. Data is scarce on prednisolone treated AI patients. Therefore we analyzed the European Adrenal Insufficiency Registry (EuAIR).
Design: EuAIR with 19 centres across Germany, The Netherlands, Sweden, and the UK started enrolling patients with AI in August 2012. Patients on hydrocortisone or dexamethasone were excluded from this analysis as were patients with congenital adrenal hyperplasia. An individual patient could appear in more than one category for dose or frequency, but each patient is represented only once within a particular category.
Results: Up to November 2014, 64 patients (62.5% females) on replacement therapy with prednisolone were registered in EuAIR (26 primary AI and 38 secondary AI). The overall mean age of patients was 58.3±16.7, the mean duration of disease 24.0±12.9 years. 14.1% of patients received <4 mg, 14.1% 4<5 mg, 65.6% 5<6 mg, and 21.8% >6 mg prednisolone/day. 73.4% received prednisolone once daily, 29.7% twice, and 1.6% trice daily. Mean BMI was 27.0±3.7 kg/m2; 45.3% of patients were overweight and 20.3% obese. Approximately a third of patients had a diagnosis of hypertension (31.3%) and dyslipidemia (35.9%). Systolic and diastolic blood pressure, and LDL-cholesterol, HDL-cholesterol and triglyceride levels were also analysed.
Conclusions: This is the largest cohort of prednisolone treated AI patients reported so far. A considerable proportion seems to be treated with too high daily doses. In addition, in real life, a substantial proportion of patients use prednisolone more frequently than once daily.