We here report the cases of two patients receiving glucocorticoid replacement, whose treatment has been guided by serum prednisolone measurements and whose day curves are presented below. Ms B was a 33-year-old patient who presented 3 years ago with panhypopituitarism following transsphenoidal surgery in 2012, for a sellar mass in a foreign country. She had already commenced 5mg prednisolone daily in addition to DDAVP, levothyroxine and the COCP. Having noticed mild weight gain, a prednisolone profile was performed. Her 8-hour level was 29.9 μg/l (target: 10 μg/l-20 μg/l), suggesting over-replacement. A repeat day curve was performed on 3mg with an 8-hour level of 15.8 μg/l. She has continued on 3mg, remaining asymptomatic. We continue to monitor her weight.
Mr T is a 57-year-old gentleman who presented 18 months ago with bitemporal hemianopia and headache secondary to pituitary macroadenoma. Following transsphenoidal resection 1 month later, he commenced prednisolone 5 mg, levothyroxine and testogel. He reported abdominal striae and adiposity, and was weaned down to 3 mg. A prednisolone profile showed an 8-h level of 22.4 μg/l. Given that he was over-replaced, another curve was done on 2 mg, showing this to be an appropriate dose (8-h level: 12.3 μg/l). Concurrent cortisol levels were noted to be 441 nmol/l at the time. Prednisolone was stopped and he is currently being monitored off replacement. Prednisolone 8-h serum levels have been successfully used to appropriately reduce replacement. Using prednisolone, we were able to identify recovery of the adrenal axis, which would have been more difficult using hydrocortisone therapy.