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Endocrine Abstracts (2016) 44 FUT1.1 | DOI: 10.1530/endoabs.44.FUT1.1

SFEBES2016 Futures Futures 1: My future career in endocrinology? (3 abstracts)

This house believes that prednisolone should be the first line for glucocorticoid replacement in adrenal insufficiency: The case FOR…

Karim Meeran


Imperial College, London, UK.


Natural hormones are continuously secreted and metabolised and thus have a short half-life. When administered exogenously, either the natural hormone needs to be administered often, or analogues with longer half-lives are given. For insulin, slow release (zinc suspensions) have been used, and more recently, the molecule has been extensively modified to give longer lasting insulins. Similarly, hydrocortisone can be given as a slow release or modified release preparation, or the molecule can be modified to lengthen its half-life. Prednisolone by virtue of a single double bond binds more than twice as avidly to the Glucocorticoid Receptor and has a longer half-life than hydrocortisone.

The combination of the increased binding and longer half-life renders prednisolone six times more potent than hydrocortisone. Thus 3 mg prednisolone taken once daily is similar to 20 mg hydrocortisone in divided doses. Levels of prednisolone can now be used to monitor replacement, and an 8-hour level of between 10 and 20 mcg/l is adequate replacement.

Traditionally replacement has been with higher doses such as 20 mg +10 mg hydrocortisone, or 5 mg prednisolone as it was believed that an excess of steroid reduced the risk of an Addisonian crisis without harm, but even a slight excess is now thought to be harmful. Audits of patients reveal that patients on excessive doses have more osteoporosis than expected. Because prednisolone is widely used in larger doses for autoimmune diseases, the rate of side effects in those on prednisolone is artificially elevated compared to hydrocortisone. However a once daily replacement dose of between 3 mg and 4 mg daily avoids the high afternoon and evening levels that occur with hydrocortisone, especially when patients take a dose late. Once daily prednisolone mimics the normal endogenous circadian rhythm better than other glucocorticoids.

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Volume 44

Society for Endocrinology BES 2016

Brighton, UK
07 Nov 2016 - 09 Nov 2016

Society for Endocrinology 

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