Evaluation of glucocorticoid weaning practices in a tertiary centre

Leng Lui Shireen Siow; Katharine Lazarus; Vijay Ramadoss; Louisa Cheong; Karim Meeran; Eng Pei Chia

doi:10.1530/endoabs.109.P35

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Endocrine Abstracts (2025) 109 P35 | DOI: 10.1530/endoabs.109.P35

SFEBES2025 Poster Presentations Adrenal and Cardiovascular (61 abstracts)

Evaluation of glucocorticoid weaning practices in a tertiary centre

Shireen Siow Leng Lui ¹ , Katharine Lazarus ² , Vijay Ramadoss ³ , Louisa Cheong ¹ , Karim Meeran ² & Pei Chia Eng ¹

Author affiliations

¹Division of Endocrinology, Department of Medicine, National University of Singapore, Singapore, Singapore; ²Department of Endocrinology, Imperial College London, London, United Kingdom; ³Ministry of Health Holdings, Singapore, Singapore

Background: Prolonged and increased cumulative use of glucocorticoids (GCs) suppress the hypothalamic-pituitary-adrenal axis (HPA) leading to glucocorticoid-induced adrenal insufficiency (GI-AI). There is limited evidence and no consensus as to whether thrice-daily shorter-acting hydrocortisone (HC) or once daily longer acting prednisolone is more effective in allowing recovery of the endogenous cortisol production whilst GCs are weaned.

Aim: To evaluate current GC weaning practices at our centre, including the rate of GC-dose reduction for recovery of the HPA axis.

Methods: One-year retrospective study for patients attending the endocrine clinic with GI-AI.

Results: Forty-five patients were referred for GI-AI, of which 39 were on HC and 6 were on prednisolone. 42.2% (19/45) were successfully weaned off GCs over an average of 9.2 months, requiring 2-3 clinic appointments. Twenty-six patients (57.7%) remained on GC after one year. Of those who were successfully weaned, 17/39 (43.5%) were on HC and 2/6 (33.3%) were on prednisolone. HC dose reduction occurred at an average of 2.8 mg reduction per month over a nine month period. All patients underwent an SST prior to being completed weaned, patients underwent an average of two SSTs during their GC wean. Mean baseline cortisol was 136nmol/l and no difference in baseline cortisol level between those who were successfully weaned and those who were not weaned off GC. Five patients (11.1%) had also used other forms of GCs – including inhaled (6.6%) and topical (4.4%) GCs. Seven patients had previously used herbal and traditional Chinese medicine, which was felt to be the cause of their HPA axis suppression. Fourteen (31.1%) patients experienced glucocorticoid-withdrawal symptoms (GWS). The symptoms reported included: dizziness (13.3%), hypotension (4.4%) and fatigue (15.6%).

Conclusion: Both HC and prednisolone can be used to successfully wean patients off long-term GCs, allowing for recovery of the HPA axis.

Keywords: Cortisol, adrenal insufficiency, weaning