title: Prednisolone is associated with a worse lipid profile than hydrocortisone in patients with adrenal insufficiency.
abstract: OBJECTIVE
  Prednisolone is used as glucocorticoid replacement therapy for adrenal insufficiency (AI). Recent data indicate that its use in AI is associated with low bone mineral density. Data on risk factors for cardiovascular disease in patients with AI treated with prednisolone are scarce, despite this condition being the predominant cause of excess mortality. We aimed to address this question using real-world data from the European Adrenal Insufficiency Registry (EU-AIR).
  
  
  METHODS
  EU-AIR, comprising of 19 centres across Germany, the Netherlands, Sweden and the UK, commenced enrolling patients with AI in August 2012. Patients receiving prednisolone (3-6 mg/day, n = 50) or hydrocortisone (15-30 mg/day, n = 909) were identified and grouped at a ratio of 1:3 (prednisolone:hydrocortisone) by matching for gender, age, duration and type of disease. Data from baseline and follow-up visits were analysed. Data from patients with congenital adrenal hyperplasia were excluded.
  
  
  RESULTS
  Significantly higher mean ± s.d. total (6.3 ± 1.6 vs 5.4 ± 1.1 mmol/L; P = 0.003) and low-density lipoprotein (LDL) cholesterol levels (3.9 ± 1.4 vs 3.2 ± 1.0 mmol/L; P = 0.013) were identified in 47 patients on prednisolone vs 141 receiving hydrocortisone at baseline and at follow-up (P = 0.005 and P = 0.006, respectively). HbA1c, high-density lipoprotein and triglyceride levels, body mass index, systolic and diastolic blood pressure and waist circumference were not significantly different.
  
  
  CONCLUSIONS
  This is the first matched analysis of its kind. Significantly higher LDL levels in patients receiving prednisolone relative to hydrocortisone could predict a higher relative risk of cardiovascular disease in the former group.
authors.affiliation: Endocrinology in CharlottenburgBerlin, Germany marcusquinkler@t-online.de.
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
authors.affiliation: Departments of Endocrinology and Medical and Health SciencesLinköping University, Linköping, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Ekman
authors.affiliation: Shire International GmbHZug, Switzerland.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marelli
authors.affiliation: ShireLexington, Massachusetts, USA.
authors.forename: Sharif
authors.initials: S
authors.lastname: Uddin
authors.affiliation: Department of Internal Medicine and EndocrinologyUniversity Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Pierre
authors.initials: P
authors.lastname: Zelissen
authors.affiliation: Department of EndocrinologyLeeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Murray
keywords: cardiovascular risk; cholesterol; low-density lipoprotein cholesterol; primary adrenal insufficiency; secondary adrenal insufficiency