Faculty Collaboration Database

Impact of hydrocortisone vs prednisone therapy on postsurgical recovery in patients with endogenous hypercortisolism: a prospective cohort study. Eur J Endocrinol 2025 Apr 30;192(5):621-630

Date

05/03/2025

Pubmed ID

40317190

Pubmed Central ID

PMC12080359

DOI

10.1093/ejendo/lvaf092

Scopus ID

2-s2.0-105005470237 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

OBJECTIVE: Glucocorticoid withdrawal syndrome (GWS) may develop in patients following successful surgery for endogenous hypercortisolism. Effective strategies to minimize GWS and improve quality of life (QoL) are currently lacking. We aimed to determine the impact of hydrocortisone vs prednisone therapy on GWS and QoL during the first 12 weeks postsurgery.

METHODS: Single-center prospective cohort study (2019-2024) of adults with endogenous hypercortisolism who developed postoperative adrenal insufficiency and treated with either prednisone or hydrocortisone. Quality of life was assessed with Short Form-36 (SF-36) and Cushing QoL questionnaires at baseline and at 12 weeks postsurgery. GWS was assessed using weekly AddiQoL questionnaires for the first 12 weeks postsurgery.

RESULTS: Of 165 patients, 101 (61%) were treated with hydrocortisone and 64 (39%) with prednisone. At baseline, no group differences were found in the hypercortisolism subtype, comorbidities, or QoL assessments. At follow-up, no group differences in final total daily hydrocortisone equivalent dose were seen.When adjusting for the baseline QoL assessment, patients treated with prednisone demonstrated a higher degree of improvement in their QoL, particularly in the SF-36 mental component score (estimate 0.33, 95% CI, 0.04-0.63), SF-36 role-emotional limitation (estimate 0.52, 95% CI, 0.2-0.84), and SF-36 body pain (estimate 0.31, 95% CI, 0.07-0.56) subcomponents. In the multivariable analysis of age, sex, body mass index, glucocorticoid type, baseline clinical severity score, and baseline QoL assessment, prednisone therapy was an independent predictor of better SF-36 mental component at 12 weeks postsurgery.

CONCLUSIONS: Prednisone therapy was associated with better mental health QoL than hydrocortisone at 12 weeks postsurgery in patients with hypercortisolism.

Author List

Sandooja R, Saini J, Ferreira Taveras E, Gregg-Garcia R, Zhang CD, Fell V, Peersen A, Achenbach SJ, Atkinson EJ, Van Gompel JJ, Young WF, Bancos I

Author

Catherine Zhang MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adrenal Insufficiency
Adult
Aged
Cohort Studies
Cushing Syndrome
Female
Glucocorticoids
Humans
Hydrocortisone
Male
Middle Aged
Postoperative Complications
Prednisone
Prospective Studies
Quality of Life
Treatment Outcome