Endocrine Abstracts (2017) 50 P018 | DOI: 10.1530/endoabs.50.P018

Prednisolone should be first line replacement therapy for adrenal insufficiency

Hemanth Prabhudev1, David Smith1, Sirazum Choudhury2 & Karim Meeran2


1Imperial College Healthcare NHS Trust, London, UK; 2Imperial College, London, UK.


Introduction: We offer patients needing glucocorticoid replacement in primary and secondary adrenal insufficiency the choice of either once daily prednisolone or thrice daily hydrocortisone. A recent European study found no difference between prednisolone and hydrocortisone users in several markers, including glucose, weight, body mass index (BMI), systolic and diastolic blood pressure and waist circumference, although they did suggest an increase in cholesterol and low density lipoprotein (LDL) in a subgroup of these patients.

Method: Data from 79 patients on hydrocortisone and 62 patients on prednisolone for adrenal insufficiency attending Imperial College Healthcare NHS Trust was collected.

Results: In contrast to the other European study (1), we found that there was no significant difference in total cholesterol and LDL levels between hydrocortisone and prednisolone patients. There was no difference in any other risk factors.

Hydrocortisone (n=79)Prednisolone (n=62)P-value
Dose (mg)20.44 (6.40)3.60 (1.04)<0.0001
SBP (mmHg)128.5 (18.8)127.0 (18.4)0.64
DBP (mmHg)78.9 (11.20)77.3 (8.8)0.36
Waist circumference (cm)100.8 (19.33)97.6 (13.2)0.30
Hip circumference (cm)107.2 (15.42)106.1 (11.19)0.67
Weight (kg)79.9 (17.5)79.8 (15.6)0.95
Height (m)1.66 (0.09)1.68 (0.12)0.40
HbA1c (mmol/mol)43.6 (15.5)40.8 (11.5)0.26
Total Cholesterol (mmol/l)5.09 (1.28)4.76 (1.07)0.12
HDL (mmol/l)1.42 (0.43)1.33 (0.36)0.24
LDL (mmol/l)2.83 (1.02)2.75 (0.91)0.66
Glucose (mmol/l)6.66 (3.20)5.90 (3.04)0.18
BMI kg/m228.97 (6.33)28.49 (5.35)0.64
Waist hip ratio0.94 (0.10)0.92 (0.07)0.31
Mean (SD), hydrocortisone v/s prednisolone.

Conclusions: Prednisolone once daily is more convenient than hydrocortisone thrice daily, and there is no difference in all the markers of cardiovascular risk measured. Because prednisolone mimics the circadian rhythm better than other glucocorticoids, it should be the first line therapy for adrenal insufficiency.

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