Background In showing no correlation between adrenal insufficiency risk and dose or duration of steroid treatment, previous reference papers have blurred our comprehension and practice (1).
Objectives To determine the extent to which long-term corticosteroid therapy damages the pituitary-adrenal axis in patients treated with prednisone medication for systemic disorders.
Methods We retrospectively studied all consecutive patients followed in our department from January 2011 to August 2012 in whom short synacthen test (SST) was assessed when withdrawal of prednisone was planned. Age, sex, disease status, duration and cumulative dose of glucocorticoid therapy were systematically recorded. SST was considered blunted when the 60 minutes plasma cortisol concentration was below 550 nmol per liter.
Results Sixty consecutive patients suffering various systemic diseases were studied (Table 1). The mean daily dose of prednisone at study time was 7 (±2) (range: 5-10) mg. Median duration and cumulative dose of prednisone were 3.8 years (range: 0.3-32) and 16.6 grams (1-132), respectively. The SST response was blunted in 29 patients (48.3%) and normal in 31. Blunted responses were associated with higher cumulative prednisone dose (p=0.04) and treatment duration (p=0.04) (Table1 and 2). Basal cortisol concentrations negatively correlated with both duration (r=-0.33, p=0.01) and cumulative dose (r=-0.28, p=0.03) of prednisone. Steroids were stopped in 29/31 (93.5 %) patients showing a normal response to SST. In this case, no patient required hydrocortisone replacement for a mean follow-up of 10 (± 6) months.
Conclusions Adrenal insufficiency is frequent in patients treated with long-term glucocorticoid for systemic disorders. Adrenal insufficiency risk may be appraised adequately on the basis of cumulative dose and duration of glucocorticoid therapy.
Schlaghecke R, et al. N Engl J Med 1992;326:226-230.
Disclosure of Interest None Declared