ECE2014 Poster Presentations Adrenal cortex (56 abstracts)
Introduction: Systemic glucocorticoid therapy may put patients at risk for later adrenal failure during times of stress, but tapering increases cumulative steroid exposure. We prospectively evaluated adrenal function and clinically relevant hypocortisolism after abruptly stopping prednisone treatment in patients with exacerbated COPD.
Methods: This is a pre-specified analysis of the REDUCE randomized trial (Journal of American Medical Association, 2013). Patients were treated with 40 mg prednisone daily for 5 or 14 days in a placebo-controlled fashion. Adrenal function was assessed by the low dose (1 μg) Synacthen stimulation tests (SST) prior to administering the first glucocorticoid dose, on day 6 before initiating blinded treatment, and on the day of discharge. The test was performed on day 30 if patients were biochemically suppressed at discharge, and repeated on days 90 and 180 unless results became normal. Patients with pathological tests at discharge were instructed about hydrocortisone substitution in situations of stress.
Results: From a total of 311 patients, 274 patients underwent SSTs and were included in this analysis (mean age 69.7 years, 61.3% males). SSTs were pathological at baseline in 15%. Mean basal/stimulated serum total cortisol levels were highest on admission (496/816 nmol/l) and lowest on day 6 (235/453 nmol/l), showing a steady increase thereafter. Among the patients tested, insufficient SST were found in 63, 38, 9, 3, and 2% at time points day 6, discharge, and days 30, 90, and 180, without significant difference in patients with 5 or 14 days exposure (P>0.05).
There were no hospitalizations or deaths due to adrenal crisis.
Conclusions: Despite frequent biochemical adrenal suppression, stopping systemic glucocorticoids abruptly after up to 14 days treatment with 40 mg prednisone daily appeared safe in patients provided with instruction on stress prophylaxis.