Endocrine Abstracts

JOINT3654

Background: Multiple daily doses of hydrocortisone are traditionally used as glucocorticoid replacement in patients with adrenal insufficiency. The Endocrine Society guideline suggests 3–5mg of prednisolone as an alternative. Prednisone is a pro drug that is converted to prednisolone by first pass metabolism in the liver. We compared the metabolic profile of patients taking multiple doses of hydrocortisone before and after switching to a single daily low-dose of prednisolone 2–5mg.

Methods: Patients with adrenal insufficiency were switched from multiple-daily dose hydrocortisone to 2–5mg of prednisolone and followed up after 4 months. We assessed cardiovascular risk using weight, blood pressure, waist and hip circumference, lipid profile and high sensitivity C-reactive protein. Quality of life was assessed using a modified SF-36 questionnaire. Baseline and follow-up data were compared using a paired t-test.

Results: Sixty-two participants were enrolled, of whom 48 completed the study. Eight (16.8%) had a diagnosis of primary adrenal insufficiency. The mean duration of glucocorticoid use was 11.4±8.6 years. After at least four months of prednisolone, we observed significant reductions in mean weight from 90.6 kg to 89.6 kg (P=0.007) and a significant reduction in systolic blood pressure (BP) of 6 mmHg (P=0.027). There was no difference in the waist to hip ratios between the two treatments (P=0.183). The use of prednisolone was associated with no change in total, LDL, HDL, or non-HDL cholesterol, triglycerides or hs-CRP. Use of once-daily low-dose prednisolone demonstrated an improvement in the energy/fatigue and total quality of life scores (P=0.003 and P=0.019 respectively). Patients reported prednisolone to be more convenient compared to hydrocortisone (P=0.002).

Conclusion: Single dose daily low-dose prednisolone has a lower metabolic risk profile to multiple daily doses of hydrocortisone given the lower blood pressure and weight. It is more convenient and improves subjective energy levels. We recommend low dose prednisolone or prednisone as a first line treatment for patients with adrenal insufficiency.