A comparison between hydrocortisone and prednisolone in the treatment of adrenal insufficiency - HYPER-AID study interim results from a tertiary care center

Masato Ahsan; Amy Morrison; Shailesh Gohil; Louise Boyle; Emma Bremner; Karim Meeran; Miles Levy; Narendra Reddy

doi:10.1530/endoabs.109.P27

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Endocrine Abstracts (2025) 109 P27 | DOI: 10.1530/endoabs.109.P27

SFEBES2025 Poster Presentations Adrenal and Cardiovascular (61 abstracts)

A comparison between hydrocortisone and prednisolone in the treatment of adrenal insufficiency – HYPER-AID study interim results from a tertiary care center

Masato Ahsan ^1,2 , Amy Morrison ¹ , Shailesh Gohil ^1,2 , Louise Boyle ¹ , Emma Bremner ¹ , Karim Meeran ³ , Miles Levy ^1,2 & Narendra Reddy ^1,2

Author affiliations

¹The University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; ²University of Leicester, Leicester, United Kingdom; ³Imperial College London, London, United Kingdom

Background: Adrenal insufficiency (AI) is treated with lifelong glucocorticoid replacement historically with Hydrocortisone (2-3 divided doses per day) (1). Prednisolone is an alternative option with longer half-life up to 3.2 hours and requires once daily dosage. Currently there is no clear evidence indicating the superiority of one medication over the other (2).

Objectives: To investigate the effects of hydrocortisone and prednisolone on bone health, cardiovascular risk, blood glucose levels, and overall well-being in patients with AI.

Methods: A retrospective observational study was conducted at UHL, following the established protocol for the ‘Hydrocortisone versus Prednisolone for the Treatment of Adrenal Insufficiency Disease’ (HYPER-AID Study), IRAS ID: 234243. Baseline data, including anthropometric measurements, cardiovascular (CV) risk factors, and metabolic biochemistry, were collected before switching from HC to once-daily Prednisolone and followed-up after a minimum of four months.

Results: n =18, 11 were male, with a mean age of 57.8 years and mean weight of 82.90 ± 15.2 kg. Hydrocortisone (HC) dosages, ranging from 20 to 30 mg/day, were replaced with 3 to 5 mg of prednisolone. The mean follow-up duration was 13 months. There were no significant changes in BMI (29.57 to 28.89 kg/m²), mean waist circumference (100.9 cm to 100.5 cm), or HbA1c levels (5.98% to 5.92%). Additionally, no significant differences were observed in blood pressure, heart rate, FBC, bone profile, lipid profiles, serum electrolytes, renal and liver functions, or hormonal profiles. All patients opted to continue treatment with Prednisolone due to its convenience and general wellbeing reasons.

Conclusion: Prednisolone appears to be a safe alternative to hydrocortisone (HC) as replacement therapy in adrenal insufficiency (AI) patients. Patients showed a preference for prednisolone due to the convenience of once-daily dosing. Interim analysis suggests that prednisolone is non-inferior to HC, but further research with larger cohorts is needed to confirm these findings.