Assessment of hypothalamic-pituitary-adrenal axis function after corticosteroid therapy in inflammatory bowel disease

Desrame, Jérôme; Sabaté, Jean Marc; Agher, Rachid; Bremont, C; Gaudric, M; Couturier, Daniel; Chaussade, Stanislas

doi:10.1016/s0002-9270(02)04142-4

Cited by 9 publications

(17 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is recognized that advanced age does not significantly affect the response of cortisol to corticotrophin injection [15]. Desarmé et al did not identify a relationship between TS250 response and patient age [16].…”

Section: Discussion:-mentioning

confidence: 99%

“…Data from the literature indicate that recovery from normal cortisol secretion is the rule. It is obtained between five and 12 months after withdraw of a CTC greater than one year [7,16,17]. Beyond one year after stopping CTC, fewer than 5% of patients have biological IS [18].…”

Section: Discussion:-mentioning

confidence: 99%

“…Beyond one year after stopping CTC, fewer than 5% of patients have biological IS [18]. The literature does not indicate follow-up beyond 18 months [16].…”

Section: Discussion:-mentioning

confidence: 99%

See 2 more Smart Citations

Predictive Factors of Biological Adrenal Insufficiency After a Long-Term Glucocorticoid Therapy.

Bouazzaoui¹

2019

IJAR

View full text Add to dashboard Cite

Adrenal insufficiency, glucocorticoid use, stimulation test, adrenocorticotropic hormone (ACTH). Purpose:The predictive factors of adrenal insufficiency after a prolonged, continuous course of corticosteroids is poorly documented. We evaluated it retrospectively in our department of endocrinology. Methods: The patients were included between January 2015 to January 2017 and were administered a Synacthene® 250 ug test (ST250) after substitution with hydrocortisone for at least 4 to 6 weeks. A nonresponsive test was defined by a cortisol increase below 21ug/dL, 60 min after stimulation. We studied the risk factors associated with biological adrenal insufficiency by SPSS analysis. Results: sixty seven patients were included (mean age: 42 ± 13,10 years). Mean initial dose of corticosteroids was 41,95 ± 34,16 mg/d. forty-three patients failed to respond to the ST250. The comparison between the responder group and the non-responder group at TS250 showed that the difference is significant for the basal cortisol level (p= 0,016) and for the duration of the CTC (p=0.045). Conclusion: Biological adrenal insufficiency is very common after a prolonged course of corticosteroids. Hence, clinicians should be vigilant for adrenal insufficiency at all degrees of glucocorticoid exposure.Copy Right, IJAR, 2019,. All rights reserved. …………………………………………………………………………………………………….... Introduction:-Corticosteroids are widely used in long-term treatment in many chronic diseases. They can lead to suppression of the hypothalamic-pituitary-adrenal (HPA) axis. The HPA-axis may remain suppressed following cessation of GC therapy, leaving the patient with adrenal insufficiency (AI). This deficiency is most often transitory, but can persist several months and cause non-specific symptoms such as fatigue and nausea whilst lack of the usual cortisol response to stress can lead to a potentially fatal adrenal crisis. AI has been a recognized side-effect of GC therapy since the early1950s [1][2][3]; Several studies in patients treated with CTC for rheumatoid arthritis, chronic inflammatory bowel disease (IBD) or chronic obstructive pulmonary disease have evaluated the frequency of this complication between 15 and 87% [4][5][6][7][8][9]. The Synacthene® 250 μg (TS250) test is the most widely used for screening biological IS because of its simplicity and excellent negative predictive value (97%) [5]. The commonly accepted risk factors for IS are the duration of the CTC and the total dose received [6-8], The recovery time of the hypothalamic-pituitary axis after a long-term CTC is between one and 18 months [7]. We conducted a retrospective

show abstract

Section: Discussion:-mentioning

confidence: 99%

Section: Discussion:-mentioning

confidence: 99%

See 1 more Smart Citation

Predictive Factors of Biological Adrenal Insufficiency After a Long-Term Glucocorticoid Therapy.

Bouazzaoui¹

2019

IJAR

View full text Add to dashboard Cite

show abstract

“…[30][31][32] However, more recent studies using statistical analysis found no significant correlation between the extent of HPA suppression and daily dose, cumulative dose, or duration of CS treatment. [33][34][35][36] The regimen used in the current study consisted of twice daily dexamethasone tablets, with no 'rest' days off CS until the later stages of the withdrawal regimen. We found that a longer duration of CS dependency appeared to predict a slower wean, but because of the small sample size, the estimates for factors predictive of a slow wean were unstable.…”

Section: Discussionmentioning

confidence: 99%

Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method

Murphy

Wang

Anderson³

et al. 2009

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…Over 50% of Crohn's patients treated acutely with systemic steroids become steroid dependent or steroid resistant, particularly smokers and those with colonic disease. 48 Budesonide is a potent glucocorticoid with first-pass hepatic metabolism that is formulated into microgranules for ileocecal release and possesses a high topical antiinflammatory effect without appreciable systemic activity. One-year out- comes were prolonged response in 32%, corticosteroid dependence in 28%, and operation in 38%.…”

Section: Corticosteroidsmentioning

confidence: 99%

Crohn's disease

Friedman¹,

Lichtenstein²

2006

Therapy of Digestive Disorders

View full text Add to dashboard Cite

Assessment of hypothalamic-pituitary-adrenal axis function after corticosteroid therapy in inflammatory bowel disease

Abstract: In all, 65% of the ST were abnormal. These results suggest that ST should be performed before corticosteroid withdrawal, especially in patients with recent past history of CT.

Cited by 9 publications

References 0 publications

Predictive Factors of Biological Adrenal Insufficiency After a Long-Term Glucocorticoid Therapy.

Predictive Factors of Biological Adrenal Insufficiency After a Long-Term Glucocorticoid Therapy.

Withdrawal of corticosteroids in inflammatory bowel disease patients after dependency periods ranging from 2 to 45 years: a proposed method

Crohn's disease

Contact Info

Product

Resources

About