The choice of glucocorticoid replacement in adrenal insufficiency (AI) is not uniform. Patient and healthcare professional preference, prescribing guidance and availability may influence the type and formulation of glucocorticoid used.

In this study funded by Shire International GmbH, Iqbal et al. used primary care data to capture a UK-wide picture of glucocorticoid replacement in AI. They included individuals with a read code for AI and a record of hydrocortisone or prednisolone prescription between 2010 and 2016 from the THIN (The Health Improvement Network) database. Of this cohort of 2648, 44.3% had a diagnosis of primary AI and 43.4% secondary AI (for the remainder, the diagnosis could not be determined from the read code). 72.2% were treated with immediate-release hydrocortisone, 1.7% with modified-release hydrocortisone and 26.1% with prednisolone. Numbers with either primary or secondary AI were very similar in each treatment group. Data on emergency glucocorticoid provision were not captured.

Data on prevalence of vascular risk factors (high across all groups) and on healthcare attendance are also of interest. Patients on immediate-release hydrocortisone had a mean of 6.5 GP attendances per year, with 9.5 per year in prednisolone-treated patients.

Read the full article in Endocrine Connections 8 20–31