01Mar 2019

PREDICTIVE FACTORS OF BIOLOGICAL ADRENAL INSUFFICIENCY AFTER A LONG-TERM GLUCOCORTICOID THERAPY.

  • Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital of Marrakech, Marrakech, Morocco.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

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 non-responsive 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.


  1. Sprague RG. et al. (1950) : Physiological effects of cortisone and pituitary adrenocorticotropic hormone (ACTH) in man. J Am Med Assoc, 144(16) :1341?7.
  2. Fraser CG. et al. (1952): Adrenal atrophy and irreversible shock associated with cortisone therapy. J Am Med Assoc, 149(17) :1542?3.
  3. Salassa RM. et al.(1953) : Postoperative adrenal cortical insufficiency: occurrence inpatients previously treated with cortisone. J Am Med Assoc, 152(16):1509?15.
  4. Salvatori R. (2005)?: Adrenal insufficiency?.JAMA, 294(19) : 2481?8.
  5. Chaieb L. et al. (1984)?: Le test rapide ? la 1-24 corticotrophinedansl?axecorticotrope. Presse Med, 13: 2183?7.
  6. Sampson PA. et al. (1962) : Adrenal function in surgical patients after steroid therapy. Lancet, 1: 322?5.
  7. Livanou T. et al. (1967): Recovery of hypothalamic-pituitary adrenocortical function after corticosteroid therapy. Lancet, 2(7521): 856?9.
  8. Wood JB. et al. (1965) : rapid test of adrenocortical function. Lancet, 1(7379): 243?5.
  9. Schalaghecke R. et al. (1992): The effect of longterm glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N Engl J Med, 326(4): 226?30.
  10. Rebecca M. et al. (2016): Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review Seminars in Arthritis and Rheumatism, 46 (1): 133?141.
  11. Goichot B. et al. (2007)?:Quereste-t-il de l?insuffisancesurr?nale post-corticoth?rapie ? Presse Med, 36(7) :1065?71.
  12. Cunningham SK, et al. (1983): Normal cortisol response to corticotrophin in patients with secondary adrenal failure. Arch Intern Med,143(12): 2276-2279.
  13. Oelkers W. (1998) : The role of high- and low-dose corticotrophin tests in the diagnosis of secondary adrenal insufficiency. Eur J Endocrinol, 139(6) : 567-570.
  14. Pugneta, G. et al. (2010): Frequency and factors associated with biological adrenal insufficiency screened by the 250 ugcorticotropin stimulation test after a prolonged course of systemic glucocorticoid therapy. A study of 100 patients. La Revue de m?decine interne, 31: 332?336
  15. Oliver C. et al. (1998) : Choice of diagnostic tests for adrenal cortex insufficiency. Ann Endocrinol, 59 : 31?3.
  16. Desram? J. et al. (2002)?: Assessment of hypothalamic-pituitary-adrenal axis function after corticosteroid therapy in inflammatory bowel disease. Am J Gastroenterol, 97:1785?91.
  17. Aubert H, Kuhn JM. (1990)?:Cons?quencesendocriniennes de la corticoth?rapie. Le sevraged?unecorticoth?rapie au long cours. Rev Prat, 40:544?8.
  18. Bertherat J (2002). Corticoth?rapieetfonctionsurr?nalienne. Encycl Med Chir.

[Fatima Zahra El Bouazzaoui, Bahia Habra, Sana Rafi, Ghizlane El Mghari, Nawal El Ansari. (2019); PREDICTIVE FACTORS OF BIOLOGICAL ADRENAL INSUFFICIENCY AFTER A LONG-TERM GLUCOCORTICOID THERAPY. Int. J. of Adv. Res. 7 (3). 115-119] (ISSN 2320-5407). www.journalijar.com


FATIMA ZAHRA EL BOUAZZAOUI
Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital of Marrakech, Marrakech, Morocco

DOI:


Article DOI: 10.21474/IJAR01/8608       DOI URL: http://dx.doi.org/10.21474/IJAR01/8608


Share this article