ArticleEndocrine connections2026
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.
Article in Endocrine connections, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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