Imperial College London
Alternate

Professor Karim Meeran

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Professor of Endocrinology
 
 
 
//

Contact

 

+44 (0)20 8846 1065k.meeran

 
 
//

Location

 

9E05Charing Cross HospitalCharing Cross Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Choudhury:2021:10.1530/ec-20-0473,
author = {Choudhury, SM and Tan, TMM and Lazarus, K and Meeran, K},
doi = {10.1530/ec-20-0473},
journal = {Endocrine Connections},
pages = {R66--R76},
title = {The use of prednisolone versus dual-release hydrocortisone in the treatment of hypoadrenalism},
url = {http://dx.doi.org/10.1530/ec-20-0473},
volume = {10},
year = {2021}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - The introduction of adrenocortical extract in 1930 improved the life expectancy of hyhpoadrenal patients, with further increases seen after 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 multidose regimens. 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 the risk of detrimental excess glucocorticoid exposure at later times in the day. The way forwards will involve 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 of cortisol 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.
AU  - Choudhury,SM
AU  - Tan,TMM
AU  - Lazarus,K
AU  - Meeran,K
DO  - 10.1530/ec-20-0473
EP  - 76
PY  - 2021///
SN  - 2049-3614
SP  - 66
TI  - The use of prednisolone versus dual-release hydrocortisone in the treatment of hypoadrenalism
T2  - Endocrine Connections
UR  - http://dx.doi.org/10.1530/ec-20-0473
UR  - https://ec.bioscientifica.com/view/journals/ec/aop/ec-20-0473/ec-20-0473.xml
UR  - http://hdl.handle.net/10044/1/85784
VL  - 10
ER  -
Download