Endocrine Abstracts

Background: Adrenal insufficiency (AI) requires life-long glucocorticoid substitution therapy (1), and bears significant risks of infection, cardiovascular (CV) & metabolic disease burden. Historically Hydrocortisone (HC) has been the mainstay of treatment. Prednisolone is a once-daily alternative due to a longer half-life (up to 3.2 hrs). Currently, there is no discernible evidence supporting the superiority of either medication (2).

Objective: To explore the impact of HC and Prednisolone on bone health, cardiovascular risk, glycaemia, and overall well-being among AI patients.

Methods: The retrospective observational study was carried out in University Hospitals of Leicester as per the established protocol for ‘Hydrocortisone versus Prednisolone for the Treatment of Adrenal Insufficiency Disease’ (HYPER-AID Study), IRAS ID: 234243. AI patients receiving stable HC replacement for at least 4 months were enrolled. Baseline anthropometric data, CV risk, and metabolic biochemistry data were collected prior to swapping of HC to once-daily low-dose Prednisolone (<5 mg/day), with a follow-up visit scheduled after a minimum period of four months.

Results: Out of 25 patients initially enrolled, 17 completed the study. 10/17 were male, mean age: 60.7 yrs, mean weight: 82.89 ±15.6 kg, mean duration of follow-up: 13 months. HC dosage varied from 20 to 30 mg/day, which was replaced with 3 to 5 mg of Prednisolone. There was no significant change in BMI (28.47 to 28.24 kg/m2), mean waist circumference, from 101.7 cm to 100.2 cm and HbA1C from 5.98% to 5.94%. No significant alterations were noted in blood pressure, heart rate, full blood count, bone profile, lipid profiles, serum electrolytes, renal function, liver functions and hormonal profiles. No adrenal crisis episodes, fractures or side effects were reported whilst on Prednisolone and all 17 patients wished to continue on Prednisolone due to ease-of-use and general wellbeing reasons.

Conclusion: Prednisolone as a replacement therapy in AI patients appears to be a safe alternative to HC, given no significant changes noted in bone, metabolic and anthropometric markers following the swap. Patient preference for Prednisolone over HC is noted due to ease-of-use of once-daily administration. The interim analysis indicates non-inferiority of Prednisolone compared to HC. However, additional research involving larger cohorts is necessary to validate these results.