The Use of Prednisolone versus Dual-Release Hydrocortisone in the Treatment of Hypoadrenalism

in Endocrine Connections
View More View Less
  • 1 S Choudhury, Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
  • 2 T Tan, Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
  • 3 K Lazarus, Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
  • 4 K Meeran, Endocrinology and Investigative Medicine, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland

Correspondence: Karim Meeran, Email: k.meeran@imperial.ac.uk

The introduction of adrenocortical extract in 1930, improved life expectancy to between two and five years with further increases seen with the introduction of cortisone acetate from 1948. Most patients are now treated with synthetic hydrocortisone, and incremental advances have been made with optimisation of daily dosing and the introduction of multi-dose regimens. Today there remains a significant mortality gap between individuals with treated hypoadrenalism and the general population. It is unclear whether this gap is a result of glucocorticoid over-replacement, under-replacement or loss of the circadian and ultradian rhythm of cortisol secretion, with detrimental risk of excess glucocorticoid at later times in the day. The way forwards involves replacement of the diurnal cortisol rhythm with better glucocorticoid replacement regimens. The steroid profile produced by both prednisolone and dual-release hydrocortisone (Plenadren), provide a smoother glucocorticoid profile than standard oral multidose regimens of hydrocortisone and cortisone acetate. The individualisation of prednisolone doses and lower bioavailability of Plenadren offer reductions in total steroid exposure. Although there is emerging evidence of both treatments offering better cardiometabolic outcomes than standard glucocorticoid replacement regimens, there is a paucity of evidence involving very low dose prednisolone (2-4 mg daily) compared to the larger doses (~7.5 mg) historically used. Data from upcoming clinical studies on prednisolone will therefore be of key importance in informing future practice.

If the inline PDF is not rendering correctly, you can download the PDF file here.

 

     European Society of Endocrinology

     Society for Endocrinology

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 151 151 48
PDF Downloads 187 187 54