Elsevier

The Journal of Pediatrics

Volume 143, Issue 3, September 2003, Pages 402-405
The Journal of Pediatrics

Prednisolone in the treatment of adrenal insufficiency: a re-evaluation of relative potency

https://doi.org/10.1067/S0022-3476(03)00294-4Get rights and content

Abstract

Prednisolone has unknown growth-suppressing effects relative to other steroids. We retrospectively studied 9 children (6 with congenital adrenal hyperplasia, CAH) receiving hydrocortisone replacement after switching to prednisolone (dose ratio, 1:5). Growth velocity and, in patients with CAH, 17-OHP decreased significantly. Dose reduction reversed these effects. Roughly, growth suppression relative potency for prednisolone:hydrocortisone was 15:1.

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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