Stina Willemoes Borresen1,2, Marianne Klose1, Bo Baslund2,3, Åse Krogh Rasmussen1,2, Linda Hilsted2,4, Lennart Friis-Hansen5, Henning Locht6, Annette Hansen7, Merete Lund Hetland2,8, Magnus Christian Lydolph9, Ulla Feldt-Rasmussen1,2. 1. Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 2. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 3. Center of Rheumatology and Joint Diseases. 4. Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 5. Department of Clinical Biochemistry, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark. 6. Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Frederiksberg Hospital, Frederiksberg, Denmark. 7. Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Gentofte Hospital, Gentofte, Denmark. 8. Center of Rheumatology and Joint Diseases, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark. 9. Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark.
Abstract
OBJECTIVE: Patients receiving long-term glucocorticoid treatment are at risk of developing adrenal insufficiency during treatment. We investigated the prevalence of prednisolone-induced adrenal insufficiency in the particular clinical situation where patients receive ongoing low-dose (5 mg/day) prednisolone treatment, a dose by itself too low to cover glucocorticoid needs during stress. DESIGN AND METHODS: Cross-sectional study in 42 patients with rheumatoid arthritis (29 women, aged 36-86 years) treated with 5 mg prednisolone/day, who had received prednisolone for ≥6 months (median: 66, range: 6-444 months). Adrenal function was evaluated by a 250 μg Synacthen test performed after mean 48.7 h prednisolone pause. Local assay-specific cut-off for normal adrenal function was P-cortisol ≥420 nmol/L 30 min after Synacthen injection. RESULTS: Overall, 20 of the 42 patients (48%, 95% CI: 33-62%) had an insufficient adrenal response to the Synacthen test. Including only patients who had not received concomitant treatment with any other glucocorticoid formulas within the last 3 months, 13 of 33 patients (39%, 95% CI: 25-56%) had an insufficient response. Adrenocorticotrophic hormone (ACTH) concentrations were generally low and anti-adrenal antibodies were negative indicating secondary adrenal insufficiency as the most likely diagnosis. There was no correlation between duration of treatment and 30 min P-cortisol (P = 0.62). Adrenal function did not depend on sex or seropositivity of rheumatoid arthritis. CONCLUSION: We demonstrate a high prevalence of adrenal insufficiency during ongoing low-dose prednisolone treatment. The results urge to increase focus on the condition to ensure identification and correct management of insufficient patients during stress and withdrawal. Strategies for adrenal function evaluation during ongoing low-dose glucocorticoid treatment need to be established.
OBJECTIVE:Patients receiving long-term glucocorticoid treatment are at risk of developing adrenal insufficiency during treatment. We investigated the prevalence of prednisolone-induced adrenal insufficiency in the particular clinical situation where patients receive ongoing low-dose (5 mg/day) prednisolone treatment, a dose by itself too low to cover glucocorticoid needs during stress. DESIGN AND METHODS: Cross-sectional study in 42 patients with rheumatoid arthritis (29 women, aged 36-86 years) treated with 5 mg prednisolone/day, who had received prednisolone for ≥6 months (median: 66, range: 6-444 months). Adrenal function was evaluated by a 250 μg Synacthen test performed after mean 48.7 h prednisolone pause. Local assay-specific cut-off for normal adrenal function was P-cortisol ≥420 nmol/L 30 min after Synacthen injection. RESULTS: Overall, 20 of the 42 patients (48%, 95% CI: 33-62%) had an insufficient adrenal response to the Synacthen test. Including only patients who had not received concomitant treatment with any other glucocorticoid formulas within the last 3 months, 13 of 33 patients (39%, 95% CI: 25-56%) had an insufficient response. Adrenocorticotrophic hormone (ACTH) concentrations were generally low and anti-adrenal antibodies were negative indicating secondary adrenal insufficiency as the most likely diagnosis. There was no correlation between duration of treatment and 30 min P-cortisol (P = 0.62). Adrenal function did not depend on sex or seropositivity of rheumatoid arthritis. CONCLUSION: We demonstrate a high prevalence of adrenal insufficiency during ongoing low-dose prednisolone treatment. The results urge to increase focus on the condition to ensure identification and correct management of insufficientpatients during stress and withdrawal. Strategies for adrenal function evaluation during ongoing low-dose glucocorticoid treatment need to be established.
Authors: Peter J Duncan; Heather McClafferty; Oscar Nolan; Qinghui Ding; Natalie Z M Homer; Paul Le Tissier; Brian R Walker; Michael J Shipston; Nicola Romanò; Thomas J G Chambers Journal: J Neuroendocrinol Date: 2022-07-14 Impact factor: 3.870
Authors: Pradeesh Sivapalan; Jonas Rutishauser; Philipp Schüetz; Jens-Ulrik Jensen; Charlotte Suppli Ulrik; Jörg D Leuppi; Lars Pedersen; Beat Mueller; Josefin Eklöf; Tor Biering-Sørensen; Vibeke Gottlieb; Karin Armbruster; Julie Janner; Mia Moberg; Therese S Lapperre; Thyge L Nielsen; Andrea Browatzki; Alexander Mathioudakis; Jørgen Vestbo Journal: Respir Res Date: 2021-05-21
Authors: Puja Mehta; Karim Meeran; Elizabeth Macphie; Afroze Abbas; Jonathan Rippin; Rachel C Jeffery; Venkat Reddy; Maria J Leandro; Coziana Ciurtin; Helen L Simpson; Sarah L Mackie Journal: Lancet Rheumatol Date: 2020-12-03