Endocrine Abstracts

Introduction: Rapid withdrawal from chronic glucocorticoid (GC) treatment could precipitate adrenal insufficiency (AI), GC withdrawal symptoms (GWS) or recurrence of underlying inflammatory condition. Here we report a successful GC weaning case in clinical practice.

Case Report: A 52-year-old man was treated with oral prednisolone (5-20 mg/day) for atopic dermatitis for 20 years was commenced on Dupilumab resulting in remission. Chronic steroid had led to easy bruising and weight gain. He previously tried a 3-weeks steroid weaning regimen, starting with 5 mg daily in the first week followed by 5 mg every 2-days in the second week and 5 mg every 3-days in the third week. However, on the third week, he developed severe nausea and lightheadedness and prednisolone was resumed at 10 mg. Initial investigations revealed AI with 8am cortisol of <28nmol/l and serum adrenocorticotrophic hormone (ACTH) of 13.1 pmol/l (1.6-13.9 pmol/l). Initial Short Synacthen Test (SST) confirmed AI (0-minutes cortisol 34nmol/l, 30-minutes cortisol 74nmol/l, 60-minutes cortisol 77nmol/l). He was started on a NICE-approved steroid weaning regimen, with dose of prednisolone reduced from 5 mg to 0 mg over 24 weeks.¹ He also received 6 weekly telephone consult to assess for symptoms of GWS and AI. SST on 13^th week of the regimen showed 0-minutes cortisol of 74nmol/l, 30 and 60-minutes cortisol of 121nmol/l and 134nmol/l, and on week 22 cortisols of 131nmol/l, 183nmol/l and 217nmol/l. Serum ACTH rose from 13.1 pmol/l to 24.3 pmol/l, suggesting slow corticotroph recovery². The patient is currently at 22^nd week of the regimen (1 mg three times weekly) and has not reported GWS or AI.

Conclusions: This 24-weeks GCs weaning process is safe and effective in allowing adrenal glands recovery without the adverse effects of AI or GWS. Larger studies are needed to confirm this.