Endocrine Abstracts (2018) 59 OC4.5 | DOI: 10.1530/endoabs.59.OC4.5

Hypothalamic-pituitary adrenal axis recovery rate of patients with glucocorticoid-induced adrenal insufficiency (GC-induced AI)

Chona Feliciano1, Helena Gleeson2, Jeremy Tomlinson3, Peter Nightingale1 & Matthew Willets4


1Queen Elizabeth Hospital, Birmingham, UK; 2Queen Elizabeth, Birmingahm, UK; 3University of Oxford, Churchill Hospital, Oxford, UK; 4University of Birmingham, Birmigham, UK.


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 (7–13 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.

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