An Approach to Minimising Risk of Adrenal Insufficiency When Discontinuing Oral Glucocorticoids

Nicholas, Mathew N.; Li, Stephanie K; Dytoc, Marlene

doi:10.1177/1203475417736278

Cited by 9 publications

(14 citation statements)

References 34 publications

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“…22 For courses less than 2 weeks, tapering is not necessary as the risk of rebound inflammation and adrenal suppression is low. 23 In our cohort, tapering was undertaken to reduce the total steroid dose (median 31.2 mg/per day for 10 days) and potential side-effects. The most commonly reported side-effects in our cohort were poor sleep, gastroesophageal reflux, and mood disturbance.…”

Section: Discussionmentioning

confidence: 99%

“…The current dose was extrapolated from the effective prednisolone dose guidelines for asthma exacerbations, of 30 to 50 mg daily (approximately 0.5 mg/kg/day) for 5 to 10 days 22 . For courses less than 2 weeks, tapering is not necessary as the risk of rebound inflammation and adrenal suppression is low 23 . In our cohort, tapering was undertaken to reduce the total steroid dose (median 31.2 mg/per day for 10 days) and potential side‐effects.…”

Section: Discussionmentioning

confidence: 99%

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Short‐term Oral Steroids Significantly Improves Chronic Rhinosinusitis Without Nasal Polyps

et al. 2021

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Objectives/Hypothesis: The efficacy of short-term oral corticosteroids in chronic rhinosinusitis without nasal polyps (CRSsNP) is unknown. The aim of this controlled study was to assess the immediate and long-term outcomes from a short course of a commonly used oral corticosteroid, prednisolone, in well-defined CRSsNP patients.Study Design: Prospective, observational controlled study. Methods: A prospective-controlled study of CRSsNP patients treated with prednisolone at 0.5 mg/kg tapered over 10 days and non-prednisolone treated CRSsNP patients (controls) and follow-up at 2, 6, and 12 months. Baseline and follow-up SinoNasal Outcome Test (SNOT)-22, nasal endoscopy (Lund-Kennedy), and sinus CT scan scores (Lund-Mackay) were compared.Results: At 2 months, there was a significant improvement in the SNOT-22, nasal endoscopy, and sinus CT scan scores in the prednisolone group (P < .0001) compared with controls (p = ns, Mann-Whitney U test). 52.5% of prednisolone-treated CRSsNP patients had improved symptoms and did not require sinus surgery at 12 months compared with 14.3% of controls (P < .001). Side-effects were reported in 8.9% of prednisolone-treated patients. Patients who benefited from prednisolone had a median symptom duration of 7.25 (99% confidence, upper limit of 11) months compared with 18 months in those requiring surgery.Conclusions: Short-term oral prednisolone significantly improved all three clinical measures of disease in CRSsNP patients and avoided surgical intervention in 52.5% patients in the first 12 months. Patients with symptoms for less than 11 months were most likely to benefit. The side-effects of oral steroids require careful consideration and further studies are needed to ascertain appropriate dosage and treatment duration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Short‐term Oral Steroids Significantly Improves Chronic Rhinosinusitis Without Nasal Polyps

et al. 2021

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“…Signs and symptoms of AI and hydrocortisone use, if prescribed, were documented at least 1 year after the end of hormonal treatment, because patients who had glucocorticoids for prolonged periods are considered at risk of AI up to 12 months after withdrawal 16,17 . Tests were morning cortisol level, with a diagnostic cutoff of <60 nmol·L –1 (2.2 μg/dl), and ACTH stimulation test, with a positive diagnostic peak value of <500 nmol·L –1 (18 μg/dl) 16,18,19 . The value of 60 nmol·L –1 was chosen as cutoff because it was the local laboratory standard and was more restrictive than the most restrictive value of 80 nmol·L –1 (3 μg/dl) in review articles 19,20 .…”

Section: Methodsmentioning

confidence: 99%

“…Random cortisol was not necessary to establish the diagnosis but was noted if present. Risk factors of AI were defined as molecule potency, duration of therapy, concomitant medication, illness or physical stress, and interindividual susceptibility 16,19 . Concomitant medication noted were medications that affect corticosteroid potency and those independently carrying a risk of AI 19 .…”

Section: Methodsmentioning

confidence: 99%

Adrenal insufficiency among children treated with hormonal therapy for infantile spasms

Doré-Brabant¹,

Laflamme²,

Millette³

et al. 2022

Epilepsia

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Hormonal therapy is a standard treatment for children with infantile spasms. However, the high doses given and long treatment duration expose patients to the risk of adrenal insufficiency (AI). This study aims to quantify the cumulative incidence of AI among children with infantile spasms treated with high-dose corticosteroids and/or adrenocorticotropic hormone. Methods: A retrospective chart review of patients treated for infantile spasms was performed between January 2009 and March 2020 in one pediatric specialized hospital. Variables collected include patient and treatment characteristics, risk factors of AI, and adrenal function testing. Analysis included descriptive statistics such as incidence and bivariate analysis.Results: Thirty-one patients were included and received a total of 33 courses of treatment (17 corticosteroids [prednisone/prednisolone], 12 adrenocorticotropic hormone, and four combined). Physiologic hydrocortisone replacement therapy with stress supplementation was received after 32 of 33 (97%) courses of treatment.Adrenal function was assessed in 32 of 33 (97%) and AI occurred in 25 of 33 (76%, 95% confidence interval = 58-89). No predictive factor of AI was identified after hormonal treatment. No drug regimen was found to be safe. The two patients who developed an acute adrenal crisis presented to the emergency room within the days (between 2 and 7) following weaning off of hormonal treatment. They were the youngest children of the cohort, and both received prednisolone.

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“…The true prevalence of AI in asthma is difficult to determine, in part, because of limited studies, as well as a shortage of reliable interstudy comparisons [ 13 , 34 ]. In one meta‐analysis, 48.7% of patients were diagnosed with AI after OCS use.…”

Section: Asthma Oral Corticosteroids and Adrenal Insufficiencymentioning

confidence: 99%

Long‐term corticosteroid use, adrenal insufficiency and the need for steroid‐sparing treatment in adult severe asthma

et al. 2021

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An Approach to Minimising Risk of Adrenal Insufficiency When Discontinuing Oral Glucocorticoids

Cited by 9 publications

References 34 publications

Short‐term Oral Steroids Significantly Improves Chronic Rhinosinusitis Without Nasal Polyps

Short‐term Oral Steroids Significantly Improves Chronic Rhinosinusitis Without Nasal Polyps

Adrenal insufficiency among children treated with hormonal therapy for infantile spasms

Long‐term corticosteroid use, adrenal insufficiency and the need for steroid‐sparing treatment in adult severe asthma

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