Individualized Glucocorticoid Replacement with Prednisone in Central Adrenal Insufficiency Using a Clinical Dose-Finding Algorithm
Authors' conclusion
Individualizing low-range prednisone replacement with a structured algorithm produced a dose distribution tied to patient age and body size, with comparable long-term outcomes. These findings support the use of tailored low-dose prednisone through a clinical algorithm as a safe method to avoid glucocorticoid over-and under replacement in CAI.
Study context
- Population
- Patients with central adrenal insufficiency (CAI) on long-term prednisone use, selected in their last visit (2021–2022); 63 years; 64% menpatients with CAI on long-term prednisone use
- Participants
- 77 patients
- Exposure
- Long-term outcomes across dose groups
- Outcome
- Algorithm dose distribution
Main finding
As reported in the abstract
- P value
- P = 0.001
Observational data: associations, not effects.
Further findings
| Outcome | 2.5mg | 5.0mg | P value |
|---|---|---|---|
| Bone mineral density in lumbar spine2.5mg vs 5.0mg | 1.013 g/cm² | 0.911 g/cm² | P = 0.19 |
| Bone mineral density in total femur2.5mg vs 5.0mg | 0.930 g/cm² | 0.952 g/cm² | P = 0.70 |
| Bone mineral density in femoral neck2.5mg vs 5.0mg | 0.808 g/cm² | 0.816 g/cm² | P = 0.88 |
| Prevalence of weight gain2.5mg vs 5.0mg | 51% | 33% | P = 0.25 |
| Weight gained | 5.5 (range as printed 2.25–9.75) kg | 5.0 (range as printed 3.0–14.5) kg |
- Incidence of diabetes, hypertension, dyslipidemia · 2.5mg vs 5.0mg · diabetes; no significant difference
- P = 0.74
- Incidence of diabetes, hypertension, dyslipidemia · 2.5mg vs 5.0mg · hypertension; no significant difference
- P = 0.24
- Incidence of diabetes, hypertension, dyslipidemia · 2.5mg vs 5.0mg · dyslipidemia; no significant difference
- P = 0.78
Allocation to 2.5 mg and patient characteristics
- Allocation to 2.5 mg was associated with older age and lower body weight/surface area
- P < 0.0001
Health events, self-management of prednisone and QoL
- Health events, no significant difference
- 0.45<P<0.70
- Self-management of prednisone, no significant difference
- P > 0.99
- QoL, no significant difference
- 0.13<P<0.96
Original publication
Individualized Glucocorticoid Replacement with Prednisone in Central Adrenal Insufficiency Using a Clinical Dose-Finding Algorithm. Endocr Pract. Published 12 November 2026. doi:10.
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