Endocrine Abstracts

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...

Introduction: We offer patients needing glucocorticoid replacement in primary and secondary adrenal insufficiency the choice of either once daily prednisolone or thrice daily hydrocortisone. A recent European study found no difference between prednisolone and hydrocortisone users in several markers, including glucose, weight, body mass index (BMI), systolic and diastolic blood pressure and waist circumference, although they did suggest an increase in cholesterol and low densit...

Introduction: We offer patients needing glucocorticoid replacement in primary and secondary adrenal insufficiency the choice of either once daily prednisolone or thrice daily hydrocortisone. A recent European study found no difference between prednisolone and hydrocortisone users in several markers, including glucose, weight, body mass index (BMI), systolic and diastolic blood pressure and waist circumference, although they did suggest an increase in cholesterol and low densit...

Introduction: Glucocorticoid replacement in adrenal insufficiency may be achieved by administering thrice- daily hydrocortisone or once-daily very low dose (2-4 mg) prednisolone. Prednisolone’s longer half-life enables once-daily dosing, improving patient satisfaction and compliance. At very low doses, it has shown no difference in most markers of metabolic risk when compared with hydrocortisone. At Imperial College Healthcare NHS Trust (ICHNT), use of an eight-hour troug...

Introduction: Liberal glucocorticoid replacement therapy prevents Addisonian crises in individuals with adrenal insufficiency (AI). Prednisolone is six to eight times more potent than hydrocortisone. There is inter-individual variation in glucocorticoid metabolism wherein 5 mg prednisolone once-daily may result in over-replacement in most individuals, with subsequent long-term morbidity and mortality.Methods: Data from individuals on established predniso...

Background: Adrenal insufficiency (AI) is a life-threatening condition which requires long term glucocorticoid (GC) replacement. Patient misdiagnosis results in inappropriate GC use, which has significant adverse effects and is associated with an increased mortality risk. The insulin tolerance test (ITT) is the gold standard test for diagnosis, but the widely accepted cut-off value of ≤550 nmol/l used to diagnose AI is founded on outdated immunoassays. Use of this cut-of...

We here report the cases of two patients receiving glucocorticoid replacement, whose treatment has been guided by serum prednisolone measurements and whose day curves are presented below. Ms B was a 33-year-old patient who presented 3 years ago with panhypopituitarism following transsphenoidal surgery in 2012, for a sellar mass in a foreign country. She had already commenced 5mg prednisolone daily in addition to DDAVP, levothyroxine and the COCP. Having noticed mild weight gai...

Both diabetes and Addisons’ are conditions which can be associated with muscle weakness and altered potassium levels. This is a case of recurrent muscle paralysis in a patient with both conditions with the underlying abnormality being the neurological condition of hypokalaemic periodic paralysis.A 23-year-old Caucasian gentleman was admitted to medical admissions with sudden onset weakness of his lower legs. On examination he had reduced power of hi...