Endocrine Abstracts

Introduction: Adrenal insufficiency (AI) requires lifelong steroid replacement therapy, traditionally with hydrocortisone (HC), which, taken in divided doses, mimics the normal daytime cortisol profile. Prednisolone, with its longer duration of action, presents a cost-effective, once-daily alternative, yet its comparative efficacy and safety profile in AI management still need to be explored. Therefore, the current study aims to assess the metabolic and cardiovascular outcomes in AI patients transitioning from HC to prednisolone.

Methods: The study was conducted following the protocol for ‘Hydrocortisone vs Prednisolone for the Treatment of Adrenal Insufficiency Disease’ (HYPER-AID Study), IRAS ID: 234243. Patients diagnosed with AI according to the standard diagnostic criteria, on stable HC replacement (for a minimum of four months), were recruited. Baseline assessments were conducted before switching to prednisolone, and a follow-up visit was scheduled after at least four months on the new regimen. Measurements included anthropometric data, cardiovascular risk factors, glycaemic control markers, and safety profiles. Statistical analysis was performed using SPSS statistics version 29.0, considering P<0.05 statistically significant.

Results: Fifteen patients with AI were recruited. Two patients withdrew due to altered mood and fatigue. Of 13 participants, 7 were male (53.8%), with a mean age of 60.69±11.56 years. The majority (92.3%) had secondary AI. The total daily HC dose ranged between 17.5 and 25 mg and was substituted by 3 to 5 mg of prednisolone. Notably, 61.5% of patients were effectively replaced with a 4 mg dose. At follow-up, the mean body mass index (BMI) showed a marginal decrease from 31.56±7.01 kg/m² to 30.87±6.97 kg/m² (P=0.016). Similarly, the waist circumference slightly decreased from 106.11±11.94 cm to 103.26±10.6 cm (P=0.011). Furthermore, no marked changes were observed in blood pressure, heart rate, lipid profiles, glycaemic control, serum electrolytes, renal and liver function, or haematological parameters. Interestingly, all participants opted to continue treatment with prednisolone, highlighting a preference potentially linked to the simplified administration regimen.

Conclusion: Switching from HC to prednisolone in patients with AI appears safe and results in minor yet statistically significant reductions in BMI and waist circumference, suggesting possible metabolic benefits. The absence of adverse effects on cardiovascular risk factors further supports prednisolone as a feasible, cost-effective alternative to HC in AI management. Nevertheless, further studies with larger sample sizes are required to validate these findings and assess the long-term treatment implications.