Prednisolone in the treatment of adrenal insufficiency: a re-evaluation of relative potency
Section snippets
Patients
Children with congenital adrenal hyperplasia (CAH), adrenal insufficiency, or hypopituitarism were identified through the use of the clinic database. Patients who had switched from hydrocortisone treatment to prednisolone and had at least one 6-month follow-up were included. Children with adrenal suppression from steroids given for nonendocrine diseases were excluded.
Data collection
Demographics, comorbidities, glucocorticoid type and dose, other medications, and growth measures were recorded at −6, 0, and +6
Results
Nine children, median age, 5 years, 4 months (range, 2 months-9 years, 6 months) at the start of the observation period were identified. Six had CAH (all 21-hydroxylase–deficient with salt wasting; 2 male, 4 female), 2 had hypopituitarism (1 male with septo-optic dysplasia, 1 female with absent pituitary stalk), and 1 boy had adrenocorticotrophic hormone resistance. All patients with CAH took fludrocortisone, and both patients with hypopituitarism took L-thyroxine to maintain normal free T4.
Discussion
Precise dosing of glucocorticoid replacement is important because linear growth can be affected by a relatively small excess.1 Such precision is difficult to achieve in infants and young children taking the 5-mg hydrocortisone tablet. A liquid prednisolone preparation would be the most convenient alternative, but it requires reliable knowledge of equivalency. Our observation provides a sensible starting point of 15:1, which can be subsequently titrated by patient response. However, the
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