Individualized Glucocorticoid Replacement with Prednisone in Central Adrenal Insufficiency Using a Clinical Dose-Finding Algorithm.

Authors

Pedro Felisberto Santos-Neto, André Machado Bottino, Silvia R Correa-Silva, Julio Abucham

Published in

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. Nov 12, 2026. Epub Nov 12, 2026.

Abstract

For over 30 years, we have treated patients with central adrenal insufficiency (CAI) using an in-house clinical algorithm (based exclusively on signs/symptoms) to individualize prednisone replacement within a predefined low dose range. The aim of this study is to describe prednisone dose distribution produced by this algorithm, determine associations between doses and patient characteristics, and compare long-term outcomes across dose groups.
Retrospective study. Seventy-seven patients with CAI (63 years; 64% men) on long-term prednisone use were selected in their last visit (2021-2022). Long-term outcomes were extracted from records; quality of life (QoL SF-36), health events, and patient education/self-management were assessed by recent in-person questionnaires.
Algorithm dose distribution was 2.5mg in 70%, 3.75mg in 14%, and 5.0mg in 16% (P=0.001). Allocation to 2.5 mg was associated with older age and lower body weight/surface area (P<0.0001). No significant differences were observed, respectively, between 2.5mg and 5.0mg doses for: incidence of diabetes (P=0.74), hypertension (P=0.24), dyslipidemia (P=0.78); bone mineral density in lumbar spine (1.013 vs 0.911 g/cm2, P=0.19), total femur(0.930 vs. 0.952 g/cm2, P=0.70), and femoral neck(0.808 vs. 0.816 g/cm2, P=0.88); prevalence of weight gain (51% vs. 33%, P=0.25), weight gained [5.5(2.25-9.75) vs. 5.0(3.0-14.5)kg], health events(0.450.99), and QoL(0.13Individualizing 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.

PMID:
43020467
Bibliographic data and abstract were imported from PubMed on 13 Nov 2026.

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