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Endocrine Abstracts (2022) 86 HDI2.1 | DOI: 10.1530/endoabs.86.HDI2.1

SFEBES2022 How Do I. . .? Sessions How do I...? 2 (6 abstracts)

Outstanding clinical practioner award: how do i wean patients who have had pituitary or adrenal cushings syndrome off glucocorticoids once they are in remission?

Karim Meeran

Imperial College, London, United Kingdom

Following pituitary or adrenal surgery, an undetectable morning cortisol suggests remission, and the patient needs to be discharged on replacement glucocorticoid, either thrice-daily hydrocortisone (commonly 10mg in the morning, 5 mg at noon and 2.5mg at 4pm) or once-daily prednisolone (commonly 3mg to 4mg)1. Low-dose once-daily prednisolone is seven times more potent than hydrocortisone2. Weaning prednisolone is easier than weaning hydrocortisone3. Corticosteroid replacement will be required until the axis recovers. Previous prolonged exposure to cortisol will have suppressed pituitary corticotrophs and in the case of a unilateral adrenal adenoma secreting cortisol, the contralateral adrenal may also have atrophied, further prolonging recovery of the HPA axis. Recovery can take over a year. Because the patient is acclimatised to high levels of glucocorticoids, they start of with generous replacement. Prednisolone 6mg once daily for the first week reducing to 5mg daily after a week, and then they are continued on 4mg daily. We run a uPLC-LCMS/MS assay4 and a single 6h (30-44mcg/l) or 8h (15-25mcg/l) level will suffice to confirm of refute excessive replacement. A hydrocortisone day curve is used on some units. Where levels are high, the dose can be reduced to 3mg daily. They usually stay on 3mg or 4mg for several months. An early morning cortisol is checked every 8 weeks. An early morning cortisol measured before a morning dose of prednisolone serves as a guide to HPA axis recovery. Once the morning cortisol is over 200nM, the prednisolone can be weaned further5. We are recruiting further NIHR centres to the HYPER-aid study to compare prednisolone with hydrocortisone replacement and generate evidence in favour of one of these agents. Please let me know if your centre is interested in joining this study.

Volume 86

Society for Endocrinology BES 2022

Harrogate, United Kingdom
14 Nov 2022 - 16 Nov 2022

Society for Endocrinology 

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