ECE2014 Poster Presentations Adrenal cortex (56 abstracts)
Glucocorticoid-induced adrenal insufficiency in prednisolone treated patients and how it relates to glucocorticoid dose and the duration of treatment
Stina Dinsen 1 , Bo Baslund 2 , Marianne Klose 1 , Æse Krogh Rasmussen 1 , Lennart Friis-Hansen 3 , Linda Hilsted 3 , Henning Locht 4 , Annette Hansen 5 & Ulla Feldt-Rasmussen 1
1Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 2Department of Rheumatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 3Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 4Department of Rheumatology, Copenhagen University Hospital, Frederiksberg Hospital, Copenhagen, Denmark; 5Department of Rheumatology, Copenhagen University Hospital, Gentofte Hospital, Copenhagen, Denmark.
Objective: We aimed to assess the prevalence of glucocorticoid-induced adrenal insufficiency in prednisolone treated patients, and its relation to glucocorticoid dose and duration of treatment.
Subjects and measures: As part of a larger study 48 patients with rheumatoid arthritis (33 women, aged 34–85 years) treated with a mean prednisolone dose of 7.0 mg (range 5–20 mg) per day, and a mean duration of treatment of 95 months (range: 6–360 months) had a 250 μg Synacthen test performed fasting, in the morning, after a mean prednisolone pause of 47 h (range: 36–60 h). P-cortisol was measured before, 30 and 60 min after Synacthen injection.
Results: Of the 48 patients 29 (60%) and 23 (48%) respectively, had an insufficient adrenal function using P-cortisol of 550 and 500 nmol/l as cut-off levels. An insufficient response was less frequently observed in patients treated with 5 mg prednisolone/day than above (33 vs 72%; P=0.009) with 500 nmol/l, but not with 550 nmol/l as cut-off level (50 vs 78%, P=0.06). P-cortisol correlated with prednisolone dose (0 min: r=−0.36, P=0.01, 30 min: r=−0.33, P=0.02, 60 min: r=−0.34, P=0.02), but not duration of treatment (0 min: r=−0.16, P=0.3, 30 min: r=−0.06; P=0.7, 60 min: r=−0.081, P=0.6).
Conclusion: Approximately half of the patients had suppressed adrenal function 47 h after the last prednisolone dose. Depending on cut-off level, an insufficient adrenal response tended to be less frequent in patients treated with 5 mg prednisolone/day, but still occurred in 33–50% of those patients. P-cortisol correlated negatively with prednisolone dose, but the correlation only explained 11–13% of the variation in P-cortisol. Duration of treatment was not predictive for adrenal suppression. The results indicate that a substantial number of patients in glucocorticoid therapy for rheumatoid arthritis need particular awareness when considering withdrawal in order to avoid life-threatening adrenal insufficiency.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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