Aim: To evaluate the recovery rate, characteristics and factors that might help predict the HPA axis recovery of patients with glomerulonephritis (GN) and GC-induced AI.
Study Design: A retrospective study involving all GN patients referred from January 2014-December 2016 with a confirmed diagnosis of GC-induced AI with a planned weaning from conventional Prednisolone (Pred) immunosuppression and switch onto Hydrocortisone (HC). Data collected up to November 2017.
Patients: There were a total of 38 patients (23 male) included in the study; median age of 53.
Methods: Review of demographic data, Pred lowest dose exposure (PredTime) and their detailed adrenal function assessments (short synacthen test (SST)), Test0 up to Test6 (follow up period, 7 42 months) with corresponding HC switched dosage.
Results: 25 (66%) recovered their HPA axis, median of 9 months (713 months). HC switched dosage, 15 vs 20mg daily revealed 9.3% vs 7.0% chances of recovery, respectively (P=0.008). PredTime and demographic variables were not statistically significantly different. The cortisol 30 min value, increment and ratio of the initial SST (Test0) were found to be predictors of recovery with a P value of 0.005, 0.001 and 0.007 respectively.
Conclusions: HPA axis recovery was achieved frequently in patients at approximately 9 months. A lower HC dose may influence recovery and cortisol response during a SST may be independent predictive factors for the recovery of adrenal function. A well-controlled prospective study in a larger cohort with GC-induced AI is required to strengthen the observed correlation of HC dose and cortisol response during a SST with potential recovery.