Suppression and recovery of adrenal response after short-term, high-dose glucocorticoid treatment

Henzen, Christoph; Suter, Alex; Lerch, Erika; Urbinelli, Ruth; Schorno, X.H.; Briner, Verena

doi:10.1016/s0140-6736(99)06290-x

Cited by 255 publications

(170 citation statements)

References 25 publications

Supporting

Mentioning

152

Contrasting

Unclassified

Order By: Relevance

“…However, even after a short period of glucocorticoid treatment (i.e. a median duration of less than 12 days) the adrenal response was suppressed in 45% of the patients (20). In the evaluation of the HPA axis, results of the low dose (1 mg) ACTH test correlate well with those of the insulin-induced hypoglycemia test.…”

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Adrenal function during coronary artery bypass grafting

Henzen

Kobza²,

Schwaller-Protzmann³

et al. 2003

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: To assess adrenal function in patients undergoing coronary artery bypass grafting (CABG) by means of the low-dose (1 mg) ACTH test, and to correlate the adrenal function with clinical outcome. Methods: During a 5-month period we prospectively included 45 patients undergoing elective CABG with cardiopulmonary bypass and without symptoms of endocrine disease. Low-dose (1 mg) ACTH tests were performed on the day before surgery (day 21), immediately after the operation (day 0), on the two subsequent days in the intensive care unit (day 1 and day 2), and on the day of discharge from the hospital. A number of clinical, hemodynamic and laboratory parameters were monitored throughout. Results: On day 2 1, 75% of the study patients had normal stimulated plasma cortisol concentrations. Eleven patients (25%) had an impaired adrenal response to 1 mg ACTH. The stimulated plasma cortisol concentrations in patients who had an inadequate adrenal response on day 2 1 remained significantly reduced on day 1 (756^205 vs 949^259 nmol/l, P ¼ 0.03) (mean^S.D.), day 2 (644 (580 -793) vs 885 (713-1087), P ¼ 0.03) (median (interquartile range)), and on the day of discharge (698^201 vs 854^186, P ¼ 0.05). In patients with a normal adrenal response in the preoperative setting peak cortisol concentrations were reached on day 1, in patients with a blunted adrenal response they were reached on day 2. There were significant correlations between the stimulated plasma cortisol concentrations and the blood loss (r ¼ 2 0.50, P ¼ 0.002) and volume balance (r ¼ 0.41, P ¼ 0.015). Conclusions: Occult (partial) adrenal insufficiency is common in patients undergoing CABG who are otherwise asymptomatic as regards endocrine disease. The adrenal function in these patients differs both in the magnitude of cortisol response to ACTH and in the time course, with significantly delayed peak cortisol concentrations. Adequate regulation of volume balance and the amount of blood loss seem to correlate with adequacy of adrenal function.

show abstract

Section: Discussionmentioning

confidence: 92%

“…Among the various factors leading to relative adrenal insufficiency, treatment with exogenous glucocorticoids is the most common (18). It is well recognised that adrenal function shows little correlation with the dose and duration of glucocorticoid treatment (19,20). However, even after a short period of glucocorticoid treatment (i.e.…”

Section: Discussionmentioning

confidence: 99%

Adrenal function during coronary artery bypass grafting

Henzen

Kobza²,

Schwaller-Protzmann³

et al. 2003

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…9 Adrenal gland hypoplasia and atrophy are preceded by HPA-axis suppression, which in turn has been demonstrated to occur after exposure to courses as short as five-day duration of oral corticotherapy. 10 It has been described that any subject who has taken 20 mg of prednisone for 5 days or longer is at risk of HPA axis suppression. 11 As previously shown 12 and corroborated in our study, HPA axis dysfunction at baseline conditions may already be detected at the very first week after discontinuation of OCS treatment.…”

Section: Discussionmentioning

confidence: 99%

Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?

Barra

Fontes

Cintra

et al. 2017

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

show abstract

“…One of the most worrisome and unpredictable complications is the suppression of the HPA axis, especially after abrupt cessation of glucocorticoid therapy. Neither the dosage or the duration of therapy nor a random plasma cortisol or ACTH measurement is a reliable indicator of subsequent adrenal insufficiency (3)(4)(5)(6). Furthermore, clinical symptoms are unspecific and inaccurate in predicting impaired adrenal function (5,7,8).…”

Section: Introductionmentioning

confidence: 99%

“…Neither the dosage or the duration of therapy nor a random plasma cortisol or ACTH measurement is a reliable indicator of subsequent adrenal insufficiency (3)(4)(5)(6). Furthermore, clinical symptoms are unspecific and inaccurate in predicting impaired adrenal function (5,7,8). Importantly, in situations of major stress, even mild adrenal insufficiency can be life threatening (3,(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone suppression test predicts later development of an impaired adrenal function after a 14-day course of prednisone in healthy volunteers

Neidert¹,

Schuetz²,

Müeller³

2010

European Journal of Endocrinology

View full text Add to dashboard Cite

Background: Suppression of the adrenal function after glucocorticoid treatment is common, potentially dangerous, and unpredictable. Identification of patients at risk is of clinical importance. We hypothesized that the dexamethasone suppression test predicts the development of corticosteroidinduced impaired adrenal function. Methods: We included 39 healthy male volunteers. After a 1-mg ACTH test, all participants underwent an overnight 0.5-mg dexamethasone suppression test. Participants then took prednisone, 0.5 mg/kg body weight, for 14-day. After the withdrawal of prednisone, a 1-mg ACTH test was performed and a clinical score was assessed on days 1, 3, 7, and 21. Results: On days 1, 3, 7, and 21, 100, 50, 26.5 and 32.4% of the participants had a suppressed adrenal function. The risk of developing suppressed adrenal function decreased from 44 to 0% in patients with cortisol levels after the administration of dexamethasone in the lowest and highest quartiles respectively. Receiver operating curve (ROC) analysis performed to predict a suppressed adrenal function on day 7 after the withdrawal of prednisone showed an area under the curve (AUC) of 0.76 (95% confidence interval (CI) 0.58-0.89) for cortisol after the administration of dexamethasone, which was in the range of the AUC of 0.78 (95% CI 0.6-0.9) for pre-intervention cortisol after the administration of ACTH. Basal cortisol before intake of prednisone (AUC 0.62 (95% CI 0.44-0.78)) and the clinical score (AUC 0.64 (95% CI 0.45-0.79)) had significantly lower AUCs. Conclusion: Circulating cortisol levels after a dexamethasone suppression test and a pre-interventionstimulated cortisol level are predictive of later development of a suppressed adrenal function after a 14-day course of prednisone, and are superior to a clinical score or basal cortisol levels. This may allow a more targeted concept for the need of stress prophylaxis after cessation of steroid therapy.

show abstract

Suppression and recovery of adrenal response after short-term, high-dose glucocorticoid treatment

Cited by 255 publications

References 25 publications

Adrenal function during coronary artery bypass grafting

Adrenal function during coronary artery bypass grafting

Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?

Dexamethasone suppression test predicts later development of an impaired adrenal function after a 14-day course of prednisone in healthy volunteers

Contact Info

Product

Resources

About