Cardiovascular risk profile of low-dose prednisolone and its effect on the quality of life in patients with adrenal insufficiency: the HYPER-AID observational study
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Patients with adrenal insufficiency require glucocorticoid replacement therapy either as hydrocortisone in multiple-daily doses or as low-dose prednisolone once daily. Data on the long-term safety, cardiovascular risk, and quality-of-life (QoL) outcomes of prednisolone remain limited.
Methods
In this prospective longitudinal cohort study, patients with adrenal insufficiency underwent a pre-specified switch from multiple-daily dose hydrocortisone to once-daily low-dose prednisolone (2–4 mg) as part of routine clinical care and followed up for at least four months. Cardiovascular risk was assessed using anthropometric and biochemical markers (lipid profile, HbA1c, C-reactive protein, blood pressure, and waist and hip circumference). QoL was evaluated using a modified SF-36 questionnaire. Baseline and follow-up measures were compared using paired t-tests or non-parametric equivalents.
Results
Of the 62 enrolled patients, 48 completed follow-up. The mean age was 54.5 ± 13 years; 56% were female; and 83% had secondary adrenal insufficiency. After at least four months on prednisolone, weight decreased significantly (90.6–89.6 kg, P = 0.007), accompanied by a reduction in systolic blood pressure (−5 mmHg, P = 0.032). Lipid parameters, HbA1c, and CRP remained unchanged (P > 0.05). Energy scores improved significantly (+9 points, P = 0.003), and patients reported increased treatment convenience (P = 0.002).
Conclusion
Low-dose once-daily prednisolone offers comparable cardiovascular risk to hydrocortisone while improving treatment convenience, systolic blood pressure, and SF-36 subjective energy scores. These findings support the use of prednisolone as a potentially preferable alternative in patients with adrenal insufficiency.
Patients with adrenal insufficiency require glucocorticoid replacement therapy either as hydrocortisone in multiple-daily doses or as low-dose prednisolone once daily. Data on the long-term safety, cardiovascular risk, and quality-of-life (QoL) outcomes of prednisolone remain limited.
Methods
In this prospective longitudinal cohort study, patients with adrenal insufficiency underwent a pre-specified switch from multiple-daily dose hydrocortisone to once-daily low-dose prednisolone (2–4 mg) as part of routine clinical care and followed up for at least four months. Cardiovascular risk was assessed using anthropometric and biochemical markers (lipid profile, HbA1c, C-reactive protein, blood pressure, and waist and hip circumference). QoL was evaluated using a modified SF-36 questionnaire. Baseline and follow-up measures were compared using paired t-tests or non-parametric equivalents.
Results
Of the 62 enrolled patients, 48 completed follow-up. The mean age was 54.5 ± 13 years; 56% were female; and 83% had secondary adrenal insufficiency. After at least four months on prednisolone, weight decreased significantly (90.6–89.6 kg, P = 0.007), accompanied by a reduction in systolic blood pressure (−5 mmHg, P = 0.032). Lipid parameters, HbA1c, and CRP remained unchanged (P > 0.05). Energy scores improved significantly (+9 points, P = 0.003), and patients reported increased treatment convenience (P = 0.002).
Conclusion
Low-dose once-daily prednisolone offers comparable cardiovascular risk to hydrocortisone while improving treatment convenience, systolic blood pressure, and SF-36 subjective energy scores. These findings support the use of prednisolone as a potentially preferable alternative in patients with adrenal insufficiency.
Date Issued
2026-02-18
Date Acceptance
2026-02-05
Citation
Endocrine Connections, 2026, 15 (2)
ISSN
2049-3614
Publisher
Bioscientifica
Journal / Book Title
Endocrine Connections
Volume
15
Issue
2
Copyright Statement
© 2026 the author(s) Published by Bioscientifica Ltd. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41649012
PII: e250904
Subjects
cardiovascular
glucocorticoid replacement therapy
hydrocortisone
prednisolone
Publication Status
Published
Coverage Spatial
England
Article Number
e250904
Date Publish Online
2026-02-06