SUN-443 Single Daily Dose Prednisolone has a Lower Cardiovascular Risk Compared to Multiple Daily Hydrocortisone Doses in Patients with Adrenal Insufficiency

Abstract Disclosure: E. Ssemmondo: None. Background: Multiple daily doses of hydrocortisone are traditionally used as glucocorticoid replacement in patients with adrenal insufficiency. The Endocrine Society guideline suggests 3-5mg of prednisolone as an alternative. Prednisone is a pro drug that is converted to prednisolone by first pass metabolism in the liver. We compared the metabolic profile of patients taking multiple doses of hydrocortisone before and after switching to a single daily dose of prednisolone 2-5mg. Methods: Patients with adrenal insufficiency were switched from multiple-daily dose hydrocortisone to once-daily low-dose prednisolone and followed up after 4 months. We assessed cardiovascular risk using weight, blood pressure, waist and hip circumference, lipid profile and C-reactive protein. Quality of life was assessed using a modified SF-36 questionnaire. Baseline and follow-up data were compared using a paired t-test. Results: Sixty-two participants were enrolled, of whom 48 completed the study. Eight (16.8%) had a diagnosis of primary adrenal insufficiency. The mean duration of glucocorticoid use was 11.4±8.6 years. After at least four months of prednisolone, we observed significant reductions in weight from 90.6 kg to 89.6 kg (p=0.007) and in systolic blood pressure (BP) of up to 6 mmHg (p=0.027). There was no difference in the waist to hip ratios between the two treatments (p=0.183). The use of prednisolone was associated with no change in total, LDL, HDL, or non-HDL cholesterol, triglycerides or CRP. Use of single-daily low-dose prednisolone demonstrated an increase in subjective energy and total quality of life scores (p=0.003 and p=0.019 respectively). Patients reported prednisolone to be more convenient compared to hydrocortisone (p=0.002). Conclusion: Single dose daily low-dose prednisolone is a safe and convenient alternative with a similar cardiovascular risk profile to multiple-daily dose hydrocortisone in patients with adrenal insufficiency. Additional improvements in weight, systolic blood pressure and subjective health scores offers advantages over hydrocortisone and would support larger prospective studies evaluating long-term health outcomes. Presentation: Sunday, July 13, 2025