Endocrine Abstracts

Generous glucocorticoid (GC) replacement following pituitary or adrenal surgery for Cushing’s can result in persistent suppression of the pituitary corticotrophs, evidenced by poor short synacthen test (SST) responses. Dose reduction can result in increased fatigue so patients tend to prefer to remain on higher doses. Long-term GC therapy is associated with increased morbidity and mortality. We present two cases where GC therapy was successfully weaned through a gradual tapering approach.

Case 1: A 26-year-old woman with Cushing’s syndrome underwent a left adrenalectomy for a 3.4cm left adrenal adenoma. She was discharged on once-daily Prednisolone 3mg. Subsequent SSTs showed a suboptimal response (Table 1). Given the intact right adrenal, a gradual tapering of GC dosage was initiated, allowing for recovery of the hypothalamic-pituitary-adrenal (HPA) axis and endogenous cortisol production.

Case 2: A 44-year-old woman underwent transsphenoidal hypophysectomy for Cushing’s disease. She was discharged on once-daily Prednisolone 6mg. A year later, cortisol levels indicated HPA axis recovery (Table 1) and she was gradually weaned off GC therapy, considering the preserved adrenal function. Similar to Case 1, this tapering approach facilitated successful discontinuation of GC treatment.

Discussion: These cases emphasise the importance of postoperative HPA axis reassessment in patients with surgically treated Cushing’s, as endogenous cortisol production may recover over time. Limited evidence exists regarding HPA axis recovery, and our cases contribute to the growing knowledge in this area. The proposed strategy of gradually tapering GC dosage, accompanied by clinical assessment, appears effective in facilitating the weaning process.