Assessing recovery of adrenal function in glucocorticoid-treated patients: Our strategy for screening and management.
Journal
Annals of medicine and surgery (2012)
ISSN: 2049-0801
Titre abrégé: Ann Med Surg (Lond)
Pays: England
ID NLM: 101616869
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
16
03
2022
revised:
26
04
2022
accepted:
01
05
2022
entrez:
23
5
2022
pubmed:
24
5
2022
medline:
24
5
2022
Statut:
epublish
Résumé
Long-term glucocorticoid (GC) use is the most frequent cause of adrenal insufficiency through suppression of the hypothalamic-pituitary-adrenal axis. There are no guidelines for predicting adrenal insufficiency (AI) and minimizing its risk. This is a prospective observational study carried out in the Endocrinology-Diabetology and Nutrition department between 2014 and 2021. All patients had received GC therapy for longer than 3 weeks before switching to hydrocortisone substitution, for various indications. These patients were admitted to our department for stimulation tests. We assessed the prevalence of AI, predicting factors, screening and management. In our study the GC-induced AI was found in 49% of patients. We found a strong correlation between the basal morning serum cortisol, body mass index and the peak cortisol level after stimulation tests, while no correlation was found between adrenal function and age, sex, indication of GC therapy, duration of corticosteroid therapy, cumulative dose and daily dose. Patients with GC induced AI took a mean of 12 ± 12,18 months to recover. Adrenal function recovery rate was higher in patients tested by short Synacthen than in those tested by Insulin Hypoglycemia. We demonstrated the positive correlation between serum cortisol peak levels after stimulation and body mass index. The study supports that basal cortisol level, the duration of corticoid cessation and the type of stimulation test can predict the response of cortisol to stimulation tests.
Sections du résumé
Background
UNASSIGNED
Long-term glucocorticoid (GC) use is the most frequent cause of adrenal insufficiency through suppression of the hypothalamic-pituitary-adrenal axis. There are no guidelines for predicting adrenal insufficiency (AI) and minimizing its risk.
Methods
UNASSIGNED
This is a prospective observational study carried out in the Endocrinology-Diabetology and Nutrition department between 2014 and 2021. All patients had received GC therapy for longer than 3 weeks before switching to hydrocortisone substitution, for various indications. These patients were admitted to our department for stimulation tests. We assessed the prevalence of AI, predicting factors, screening and management.
Results
UNASSIGNED
In our study the GC-induced AI was found in 49% of patients. We found a strong correlation between the basal morning serum cortisol, body mass index and the peak cortisol level after stimulation tests, while no correlation was found between adrenal function and age, sex, indication of GC therapy, duration of corticosteroid therapy, cumulative dose and daily dose. Patients with GC induced AI took a mean of 12 ± 12,18 months to recover. Adrenal function recovery rate was higher in patients tested by short Synacthen than in those tested by Insulin Hypoglycemia.
Conclusions
UNASSIGNED
We demonstrated the positive correlation between serum cortisol peak levels after stimulation and body mass index. The study supports that basal cortisol level, the duration of corticoid cessation and the type of stimulation test can predict the response of cortisol to stimulation tests.
Identifiants
pubmed: 35600196
doi: 10.1016/j.amsu.2022.103710
pii: S2049-0801(22)00470-8
pmc: PMC9114451
doi:
Types de publication
Journal Article
Langues
eng
Pagination
103710Informations de copyright
© 2022 The Authors.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Steroids. 2021 Mar;167:108788
pubmed: 33412217
J Clin Endocrinol Metab. 2019 Jan 1;104(1):17-20
pubmed: 30085278
Eur J Appl Physiol. 2007 Feb;99(3):205-16
pubmed: 17089154
Rheumatology (Oxford). 2020 Oct 1;59(10):2764-2773
pubmed: 32031663
Lancet Diabetes Endocrinol. 2015 Mar;3(3):216-26
pubmed: 25098712
BMC Nephrol. 2019 May 6;20(1):154
pubmed: 31060510
Lancet. 2021 Feb 13;397(10274):613-629
pubmed: 33484633
Semin Arthritis Rheum. 2016 Aug;46(1):133-41
pubmed: 27105755
J Clin Endocrinol Metab. 1998 Jan;83(1):88-92
pubmed: 9435421
Int J Surg. 2021 Dec;96:106165
pubmed: 34774726