Endocrine Abstracts (2001) 2 P96

Assessment of the hypothalamic-pituitary-adrenal axis in patients who have been on long term oral steroids

A Ahmed1, R Shiner2 & K Meeran1

1Endocrinology Department, Hammersmith and Charing Cross Hospital, London, UK; 2Respiratory Unit, Hammersmith and Charing Cross Hospitals, London, UK.

We assessed whether the hypothalamic-pituitary-adrenal (HPA) axis is affected after withdrawal of oral steroids in patients who have been on steroids for at least ten years. Recent advances in treatment of patients with severe asthma with inhaled fluticasone propionate, and the use of steroid sparing drugs such as methotrexate has allowed the withdrawal of long term oral steroids in patients who otherwise had steroid dependant disease.

We performed a 250 mcg short synacthen test on five patients who had been taken off oral prednisolone. All the patients had been off oral steroids at the time of the study for at least one month, and all were on inhaled fluticasone.

Three of the patients had a normal synacthen test, whereas two failed to achieve a plasma cortisol of 550nM at either 30 or 60 minutes post synacthen.

The peak cortisol in the two patients who failed was 475 and 393nM. The latter patient had had difficulty coming off oral steroids and had required several courses of oral prednisolone until one month before the test. The others had all stopped prednisolone for at least four months. All patients were on Fluticasone 500mcg three times a day.

This study shows that a normal synacthen test can be achieved four months after stopping oral prednisolone, even in patients who continue taking inhaled fluticasone.

The short synacthen test remains a useful tool for the assessment of the HPA axis, even in patients with previous long term steroid dependence.

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