Intended for healthcare professionals

Editorials

Glucocorticoid replacement

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4843 (Published 30 July 2014) Cite this as: BMJ 2014;349:g4843

Be careful of synthetic glucocorticoids

I read with interest Karim Meeran’s article on glucocorticoid replacement. This is a real can of worms!

I agree that the data from the Plenadren trial did not provide evidence for either better or worse responses from this new formulation. I do however, think it is important not to consider that all glucocorticoids are the same – and that Prednisolone (or Dexamethasone for that matter) has the same therapeutic effect as hydrocortisone. The binding of both Prednisolone and Dexamethasone to the glucocorticoid receptor are both very different from that of hydrocortisone, resulting in very different transcriptional effects when the steroid is administered in a physiological pulsatile pattern (Stavreva et al, Nature Cell Biology 2009; 11: 1093-1102). Until we have studies of genuine physiological replacement and compare them with current regimens of both physiological and synthetic steroids, we really will not know what is best for our patients, and how we can prevent steroid side-effects whilst maintaining optimal hormone replacement effects.

Competing interests: No competing interests

11 August 2014
Stafford L Lightman
Professor of Medicine
University of Bristol
Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Dorothy Hodgkin Building, Whitson Street, Bristol BS1 3NY