Endocrine Abstracts

Background: Patients with adrenal insufficiency sometimes complain of excessive weight gain or feeling unwell on standard hydrocortisone despite dose optimisation. Prednisolone can be used in adrenal insufficiency but has a more prolonged duration of action and blood tests to monitor prednisolone levels are not readily available. Conventional glucocorticoid replacement can lead to over-replacement particularly in the evening which is thought to increase the risk of obesity. Plenadren is a modified dual release preparation of hydrocortisone designed to be taken once daily. In a study of 64 patients with primary adrenal insufficiency, it was found to have a more physiological cortisol day profile compared to thrice daily conventional hydrocortisone. In another study, average weight loss at end of 12 weeks therapy was 0.7 kg compared to standard hydrocortisone. There was significant improvement in systolic and diastolic blood pressure readings.

Audit aim: To ensure that Plenadren was used in appropriately selected patients and assess benefit of therapy.

Results: Eight patients were commenced on Plenadren between May 2013 and December 2014. One patient discontinued Plenadren as they felt worse on it. There was an average weight loss of 1.96 kg with Plenadren therapy (6 months data in five patients and three months data in two patients). More impressive weight losses occurred in those prescribed Plenadren in view of excessive weight gain (average loss 5.4 kg excluding a patient with depression/comfort eating). Hypoglycaemia improved significantly in a patient with longstanding type 1 diabetes negating requirement for insulin pump therapy. Four hours post morning hydrocortisone cortisol levels were generally better on Plenadren. One patient with Addison’s disease AddiQol score improved from 50 to 90 and another’s score worsened slightly from 102 to 92. Overall, there was a drop in systolic blood pressure but slight increase in diastolic.