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

Abstract

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