Recovery of plasma corticotrophin and cortisol levels after three-week course of prednisolone.

Abstract

Patients with chronic airflow obstruction were given a three-week course of prednisolone 40 mg per day. The (HPA) function in these patients. MethodsAll the patients studied had chronic airflow obstruction. None had received corticosteroids within three months of the study and none had cver been on long-term treatment with corticosteriods. In the first part of the study a short tetracosactrin test3 was used to assess adrenal function in eight patients before and after a three-week course of prednisolone 20 mg twice daily. In the short tetracosactrin test a basal plasma cortisol level is measured and followed immediately by an intramuscular injection of 250 jug of synthetic corticotrophin (tetracosactrin). Thirty minutes after the injection of tetracosactrin a blood sample is taken for measurement of plasma cortisol. The Address for reprint requests: Dr J Webb, Respiratory Laboratory, Brook General Hospital, Shooter's Hill Road, London SE18. 22 first tetracosactrin test was performed on the day before starting prednisolone and the second test performed on the first day after the three-week course of prednisolone 20 mg twice daily.The results of the first experiment confirmed that both the basal cortisol and the response to tetracosactrin were suppressed, and we went on to investigate the time course of the recovery of the basal cortisol and ACTH levels after a three-week course of prednisolone 40 mg daily (20 mg bd) in a further seven patients. In this second experiment basal cortisol and ACTH levels were measured on two occasions during the week before treatment and again on days 1, 2, 3, 4, and 5 after treatment with prednisolone.

Time course of response to oral and inhaled corticosteroids in non-asthmatic chronic airflow obstruction.

“…The time to peak response with inhaled treatment was shorter than with oral prednisolone (Wilcoxon rank sum test: n, = 32, n2 = 25, Z = 2 51; p < 0-01). Thirteen patients had a response to both treatments; the analysis produced the same conclusions if these patients were removed (median (range) days: beclomethasone 8 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14); prednisolone 11 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14); Wilcoxon rank sum test: n,= 19,n2 = 12;Z = 243;p < 0-01).…”

“…Baseline characteristics of the responses with and without records available for the determination of duration of effect of treatment Data No available data (n = 36) (n = 21) Day of peak effect for response 11 11 (median[range]) [1][2][3][4][5][6][7][8][9][10][11][12][13][14] [3-14] Pretreatment peak flow (1/min, mean (SD)) 223 (82) 204 (91) Percentage increase in peak flow with response 16 2 (11 1) 14 6 (10 0) (mean (SD)) time to peak effect with oral prednisolone varied from one to more than 14 (median 12) days (fig 2). In eight of the responses the daily mean PEF was still rising on the final day of the treatment period.…”

Cushing syndrome with secondary adrenal insufficiency from concomitant therapy with ritonavir and fluticasone

“…Adrenal suppression after administration of systemic corticosteroids can be prolonged (9 to 12 months) but typically only lasts a few days after shorter courses of Յ40 mg of prednisolone or its equivalent. 12 In case one, the patient also received fluconazole for a total of 43 days, which at high doses can inhibit CYP 3A4. However, fluconazole was used at standard doses and was not being administered during the period of major weight gain nor during the time of collection of cortisol and ACTH levels.…”

Corticosteroid therapy for chronic obstructive pulmonary disease

“…Thus, a two-week trial is probably sufficient to identify the vast majority of responders and should not adversely affect adrenal function. 16 The establishment of parameters to determine a significant response is difficult in this population. Subjective response is unreliable because of the euphoric effect of corticosteroids and the well-known placebo effect.…”