Endocrine Abstracts

There is no consensus on the best dosing regimen for glucocorticoid replacement therapy. The general intention is to individualize according to the clinical response and use the lowest possible maintenance dose without risking adrenal crisis.

Aim: To survey patients with adrenal insufficiency (AI) on their glucocorticoid replacement therapy dosing regimen.

Method: Patients (children and adults) were recruited via patient organizations to respond anonymously to a web-based survey. The survey was open from September 12th to December 19th 2008. Data on age and gender was not collected in order to protect individual identity.

Results: There were 1245 responders. 84% with primary AI, 11% with secondary AI and 5% unsure. 64% were from the USA, 20% from Europe and 15% from the ROW. Hydrocortisone (HC) was used by 75%, Prednisone/Prednisolone by 11%, Cortisone Acetate by 6% and Dexametasone by 4% of respondents. The median dose of hydrocortisone was the same (20 mg) for primary and secondary AI when analyzing the whole dose range (2–80 mg). The most commonly used dose was 20 mg for both primary and secondary AI, followed by 30 mg. There were differences in therapy and dosing regimens between countries.

One third of the respondents had their dose adjusted according to body weight or body surface area. These were more often primary AI patients, treated with HC and received more often a TID regimen.

Conclusion: The most commonly used treatment regimen is hydrocortisone 20 mg, with a median dose of 20 mg, which is the same for patients with primary and secondary AI.There is variation in the dosing regimens among countries. The inter-patient differences in dosing regimens highlights the efforts being made to personalize treatment of patients with adrenal insufficiency.

Declaration of interest: I fully declare a conflict of interest. Details below.

Funding: This work was supported, however funding details unavailable.