Optimising glucocorticoid replacement in adrenal insufficiency

Authors

  • Karim Meeran Imperial College, London

DOI:

https://doi.org/10.15277/bjd.2019.229

Keywords:

prednisolone, Addison’s disease, hydrocortisone, cortisol, pituitary, fludrocortisone

Abstract

Several different regimens for steroid replacement have been tried, but head to head studies of different treatments need to be more widely undertaken. Once daily treatment with prednisolone gives the most physiological profile, and studies comparing prednisolone with hydrocortisone are now being undertaken. It is likely that prednisolone 4mg daily will be the optimum treatment used.

References

Nicolaides NC, Charmandari E, Kino T, Chrousos GP. Stress-related and circadian secretion and target tissue actions of glucocorticoids: impact on health. Front Endocrinol (Lausanne) 2017;8:70. https://doi.org/10.3389/fendo.2017.00070

Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet 2014;383(9935):2152–67. https://doi.org/10.1016/S0140-6736(13)61684-0

Charmandari E, Chrousos GP, Lambrou GI, et al. Peripheral CLOCK regulates target-tissue glucocorticoid receptor transcriptional activity in a circadian fashion in man. PLoS One 2011;6(9):e25612. https://doi.org/10.1371/journal.pone.0025612

Monk TH, Buysse DJ. Exposure to shift work as a risk factor for diabetes. J Biol Rhythms 2013;28(5):356–9. https://doi.org/10.1177/0748730413506557

Sherlock M, Reulen RC, Alonso AA, et al. ACTH deficiency, higher doses of hydrocortisone replacement, and radiotherapy are independent predictors of mortality in patients with acromegaly. J Clin Endocrinol Metab 2009;94(11):4216–23. https://doi.org/10.1210/jc.2009-1097

Muller L, Quinkler M. Adrenal disease: imitating the cortisol profile improves the immune system. Nat Rev Endocrinol 2018;14(3):137–9. https://doi.org/10.1038/nrendo.2018.5

Whitaker M, Debono M, Huatan H, Merke D, Arlt W, Ross RJ. An oral multiparticulate, modified-release, hydrocortisone replacement therapy that provides physiological cortisol exposure. Clin Endocrinol (Oxf) 2014;80(4):554–61. https://doi.org/10.1111/cen.12316

Allolio B. Extensive expertise in endocrinology. Adrenal crisis. Eur J Endocrinol 2015;172(3):R115–24. https://doi.org/10.1530/EJE-14-0824

Shire Pharmaceuticals. Plenadren. Summary of product characteristics. https://www.ema.europa.eu/documents/product-information/plenadren-epar-product-information_en.pdf

Isidori AM, Venneri MA, Graziadio C, et al. Effect of once-daily, modified-release hydrocortisone versus standard glucocorticoid therapy on metabolism and innate immunity in patients with adrenal insufficiency (DREAM): a single-blind, randomised controlled trial. Lancet Diabetes Endocrinol 2018;6:173–85. https://doi.org/10.1016/S2213-8587(17)30398-4

Williams EL, Choudhury S, Tan T, Meeran K. Prednisolone replacement therapy mimics the circadian rhythm more closely than other glucocorticoids. J Appl Lab Med 2016;1(2):152–61. https://doi.org/10.1373/jalm.2016.020206

Chihaoui M, Mimita W, Oueslati I, et al. Prednisolone or hydrocortisone replacement in patients with corticotrope deficiency fasting during Ramadan result in similar risks of complications and quality of life: a randomised double-blind controlled trial. Endocrine 2019 Sep 24 [Epub ahead of press]. https://doi.org/10.1007/s12020-019-02082-w

Smith DJF, Prabhudev H, Choudhury S, Meeran K. Prednisolone has the same cardiovascular risk profile as hydrocortisone in glucocorticoid replacement. Endocr Connect 2017;6(8):766–72. https://doi.org/10.1530/EC-17-0257

Choudhury S, Machenahalli P, Tan T, Meeran K. Inadvertent treatment of hypoadrenalism with prednisolone in pemphigus: a case report. Clin Case Rep 2019;7(5):987–9. https://doi.org/10.1002/ccr3.2132

Caldato MC, Fernandes VT, Kater CE. One-year clinical evaluation of single morning dose prednisolone therapy for 21-hydroxylase deficiency. Arq Bras Endocrinol Metabol 2004;48(5):705–12. https://doi.org/10.1590/s0004-27302004000500017

Lovas K, Husebye ES. Continuous subcutaneous hydrocortisone infusion in Addison's disease. Eur J Endocrinol 2007;157(1):109–12. https://doi.org/10.1530/EJE-07-0052

Oksnes M, Bjornsdottir S, Isaksson M, et al. Continuous subcutaneous hydrocortisone infusion versus oral hydrocortisone replacement for treatment of addison's disease: a randomized clinical trial. J Clin Endocrinol Metab 2014;99(5):1665–74. https://doi.org/10.1210/jc.2013-4253

Gagliardi L, Nenke MA, Thynne TR, et al. Continuous subcutaneous hydrocortisone infusion therapy in Addison's disease: a randomized, placebo-controlled clinical trial. J Clin Endocrinol Metab 2014; 99(11):4149–57. https://doi.org/10.1210/jc.2014-2433

Kalafatakis K, Russell GM, Harmer CJ, et al. Ultradian rhythmicity of plasma cortisol is necessary for normal emotional and cognitive responses in man. Proc Natl Acad Sci USA 2018;115(17):E4091–100. https://doi.org/10.1073/pnas.1714239115

Imperial College London. Safety and efficacy of prednisolone in adrenal insufficiency disease (PRED-AID study). Published 28 January 2019. Updated 2019. Available at: http://www.isrctn.com/ISRCTN41325341 (accessed 19 April 2019).

Imperial College London. Hydrocortisone vs prednisolone in AI (HYPER-AID). Published 1 August 2018. Updated 2019. Available at: https://clinicaltrials.gov/ct2/show/NCT03608943 (accessed 19 April 2019).

Ramadan fasting in patients with corticotrope deficiency treated either by hydrocortisone or by prednisolone. Available at: https://clinicaltrials.gov/ct2/show/NCT03585829

Amin A, Sam AH, Meeran K. Glucocorticoid replacement. BMJ 2014;349:g4843. https://doi.org/10.1136/bmj.g4843

Downloads

Published

2019-12-17

Issue

Section

Current Topics