ECE2024 Poster Presentations Adrenal and Cardiovascular Endocrinology (95 abstracts)
Glucocorticoid-induced adrenal insufficiency in patients with polymyalgia rheumatica and giant cell arteritis during long-term low-dose prednisolone treatment: Prediction based on indicators of exogenous hypercortisolism in the Double Edge Study
Nanna Thurmann Jørgensen 1,2 , Jelena Stankovic 3,4 , Anja Fenger Dreyer 5,6 , Hajir Al-Jorani 5,6 , Lise Sofie Bislev 3,4 , Victor Brun Boesen 1 , Stina Willemoes Borresen 1 , Louise Lehmann Christensen 5,6 , Ulla Feldt-Rasmussen 1 , Dorte Glintborg 5,6 , Tanja Fromberg Gorlen 2,7 , Simon Bøggild Hansen 3,4 , Merete Lund Hetland 2,7 , Bente Jensen 8 , Richard Christian Jensen 5 , Marie Louise Lund 1 , Paul M Stewart 9 , Randi Tei 3,10 , Marianne Andersen 5,6 , Jens Otto Jørgensen 3,4 & Marianne Klose 1
1Copenhagen University Hospital, Rigshospitalet, Department of Endocrinology and Metabolism, Centre of Cancer and Organ Diseases, Copenhagen, Denmark; 2Faculty of Health and Clinical Sciences, Copenhagen University, Department of Clinical Medicine, Copenhagen, Denmark; 3Aarhus University Hospital, Department of Endocrinology and Internal Medicine, Aarhus, Denmark; 4Aarhus University, Department of Clinical Medicine, Aarhus, Denmark; 5Odense University Hospital, Department of Endocrinology and Metabolism, Odense, Denmark; 6University of Southern Denmark, Department of Clinical Research, Odense, Denmark; 7Copenhagen University Hospital, Rigshospitalet, Center of Rheumatology and Spine Diseases, Glostrup, Denmark; 8Copenhagen University Hospital Bispebjerg and Frederiksberg, Center of Rheumatology and Spine Diseases, Frederiksberg, Denmark; 9University of Leeds, Faculty of Medicine and Health, Leeds, UK; 10Aarhus Universitetshospital, Endocrinology and Internal medicine, Aarhus N, Denmark
Background and aim: Identifying patients with glucocorticoid-induced adrenal insufficiency poses a challenge. We investigated whether factors associated with exogenous hypercortisolism (as a proxy of overall elevated glucocorticoid exposure) could predict the risk of glucocorticoid-induced adrenal insufficiency in patients with polymyalgia rheumatica and/or giant cell arteritis during long-term low-dose prednisolone treatment.
Material and methods: Baseline data analysis of a nationwide prospective study (Double Edge/RESCUE, EudraCT:2021-002528-18) of 133 participants with polymyalgia rheumatica/giant cell arteritis treated with prednisolone for ≥12 weeks, with a current daily dose of ≤5 mg, 58 participants with adrenal insufficiency and 75 participants with normal adrenal function evaluated with a 250 μg ACTH test. The participants were evaluated for factors associated with exogenous hypercortisolism. These factors included present diagnoses of diabetes, hypertension, dyslipidaemia, and osteoporosis documented by medical history and study examinations. Study examinations included anthropometric data, blood pressure, bone mineral density assessed by dual-energy X-ray absorptiometry (DXA) scans, and blood tests for fasting glucose, haemoglobin A1c (HbA1c), and lipids. Apart from medical history, the paraclinical diagnosis of diabetes was defined as HbA1c ≥48 mmol/mol and/or fasting glucose >7.0 mmol/l; hypertension was defined as systolic and diastolic blood pressure >140/>90 mmHg; dyslipidaemia was defined as total cholesterol >5.0 mmol/l and/or low-density lipoprotein cholesterol >3.0 mmol/l; and osteoporosis was defined as a T-score ≤−2.5. Adrenal insufficiency was defined as ACTH-stimulated cortisol <420 nmol/l (Liquid Chromatography Mass Spectrometry and/or Electrochemiluminescence immunoassay Roche Elecsys Cortisol II). Logistic regression models were used to identify predictor variables.
Results: The cumulative prednisolone dose over the past six months (OR 2.9[95% CI 1.3–6.5]) and female sex (2.8[1.1–6.4]) were associated with increased risk of adrenal insufficiency, whereas this was not the case for age (1.1[1.0–1.1]) and BMI (1.0[0.9–1.0]). Neither diabetes (0.8[0.3–2.0]), dyslipidaemia (0.8[0.4–1.9],), or hypertension (0.5[0.3–1.0]) were associated with increased risk of adrenal insufficiency. However, data suggest a 3-fold increased risk in patients with osteoporosis (2.9[1.4–6.1]), also after adjusting for age, sex, and BMI (all OR 2.2–2.7), but not after adjusting for the cumulative prednisolone dose (2.2[1.0–4.8]).
Conclusion: • Accumulated prednisolone dose may be a major predictor of adrenal insufficiency during prolonged low-dose prednisolone treatment.
• The risk of glucocorticoid-induced adrenal insufficiency is higher in females and is associated with osteoporosis.
• The data may aid in providing evidence-based risk stratification and prevention programmes for prednisolone-treated patients.
Funding: NNF20OC0063280
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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