Endocrine Abstracts

Once daily oral prednisolone has been shown to mimic the normal circadian rhythm better than other glucocorticoids. Our advice is to take prednisolone first thing on waking and before breakfast to try to mimic the normal circadian rhythm as closely as possible. The leaflet that comes with prednisolone suggests that it should be taken with food. Enteric-coated prednisolone (EC) is believed to be kinder on the stomach, but there is no evidence for its use. We compared EC with st...

Replacing glucocorticoids in patients with adrenal insufficiency is challenging, as endogenous cortisol levels rise before waking. Currently we use steroid replacement first thing in the morning. Administration of a delayed release preparation last thing at night, if reliable, could mimic the rise in cortisol that occurs before waking. Lodotra is a modified release prednisone that has a delay in the onset of action, and when given last thing at night, might cause a rise in lev...

Once daily oral prednisolone has been shown to mimic the normal circadian rhythm better than other glucocorticoids. Our advice is to take prednisolone first thing on waking and before breakfast to try to mimic the normal circadian rhythm as closely as possible. The leaflet that comes with prednisolone suggests that it should be taken with food. Enteric-coated prednisolone (EC) is believed to be kinder on the stomach, but there is no evidence for its use. We compared EC with st...

Replacing glucocorticoids in patients with adrenal insufficiency is challenging, as endogenous cortisol levels rise before waking. Currently we use steroid replacement first thing in the morning. Administration of a delayed release preparation last thing at night, if reliable, could mimic the rise in cortisol that occurs before waking. Lodotra is a modified release prednisone that has a delay in the onset of action, and when given last thing at night, might cause a rise in lev...

Mrs SP was a 50-year old patient who presented with typical features of Cushing’s syndrome in 2003 and proceeded to pituitary surgery. Following this she was not cured, and elected to have a bilateral adrenalectomy. Following this, she was initially commenced on hydrocortisone 30 mg daily taken as 15 mg in the morning, 10 mg at noon and 5 mg at 1600 h, and fludrocortisone 100 μg daily. She continued on this for 10 years, but switched her glucocorticoid replacement to...

A 33 year-old male bus driver with long standing pemphigus requiring high dose prednisolone, presented with acromegaly in 2001. MRI pituitary revealed a 2×2×0.5 cm pituitary adenoma and his GH levels of 14.8–16.4 nmo/L throughout and were not suppressible with glucose. His IGF1 was 191 nmol/l (normal range: 13–64 nmol/L), Prolactin 6,557 milliunit/L, testosterone 2 nmol/L and cortisol uninterpretable as he was on prednisolone. Trans-sphenoidal hypophysectom...

Objective: To investigate a selection of novel bone or immunomarkers which may act as indicators for steroid replacement in Adrenal Insufficiency (AI).Introduction: AI is a condition where individuals are not able to produce sufficient steroids for their body’s requirement. Although mortality rates have improved since the introduction of exogenous steroid replacement, this condition is still associated with increased mortality and morbidity. This co...

Background: Short Synacthen Tests (SSTs) are integral to the diagnosis of Adrenal Insufficiency (AI). A 30-minute stimulated cortisol value is assessed against local assay dependent thresholds to ascertain or exclude the diagnosis. A diagnosis of AI is a life changing event requiring the initiation of life long glucocorticoid replacement therapy for survival. Glucocorticoid replacement is associated with long term morbidity and mortality, including an increased risk of diabete...

Background: Management of adrenal insufficiency (AI) with glucocorticoid replacement is associated with increased mortality and morbidity. There is growing evidence that this is because of excess, non-physiological steroid exposure. Low dose prednisolone (2-4 mg) is a once-daily alternative to standard hydrocortisone regimens that more closely mimics the circadian rhythm and may translate to better outcomes. There is however a paucity of studies comparing the two treatments.</...

Background: Adrenal insufficiency (AI) is a life-threatening condition if left unmanaged. Despite treatment patients can expect a life expectancy that is shortened by 12 years secondary to probable inherent over-replacement associated with oral glucocorticoid regimens. Thrice-daily hydrocortisone is the most common regimen used. Very low-dose prednisolone (2-4 mg) is an alternative with lower uptake due to the absence of evidence for its use. This study fills this literature g...