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Original Article
Clinical Study
Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency
Jong Ha Baek, Soo Kyoung Kim, Jung Hwa Jung, Jong Ryeal Hahm, Jaehoon Jung
Endocrinol Metab. 2016;31(1):153-160.   Published online March 16, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.1.153
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  • 11 Web of Science
  • 10 Crossref
AbstractAbstract PDFPubReader   
Background

The chronic use of glucocorticoids (GC) suppresses function of the hypothalamic-pituitary-adrenal axis and often results in secondary adrenal insufficiency (AI). The present study aimed to determine the recovery rate of adrenal function in patients with secondary AI within 1 to 2 years and to assess the factors predictive of adrenal function recovery.

Methods

This was a retrospective observational study that enrolled patients diagnosed with GC-induced secondary AI between 2007 and 2013. AI was defined by peak serum cortisol levels <18 µg/dL during a standard-dose short synacthen test (SST). A follow-up SST was performed after 1 to 2 years, and responders were defined as those with adrenocorticotropic hormone (ACTH)-stimulated peak serum cortisol levels ≥18 µg/dL.

Results

Of the total 34 patients diagnosed with GC-induced secondary AI at first, 20 patients (58.8%) recovered normal adrenal function by the time of the follow-up SST (median follow-up period, 16.5 months). Although the baseline serum ACTH and cortisol levels at the first SST did not differ between responders and non-responders, the incremental cortisol response during the first SST was higher in responders than that of non-responders (7.88 vs. 3.56, P<0.01). Additionally, higher cortisol increments during the first SST were an independent predictive factor of the adrenal function recovery (odds ratio, 1.58; 95% confidence interval, 1.02 to 2.46; P<0.05).

Conclusion

In the present study, adrenal function recovery was achieved frequently in patients with GC-induced secondary AI within 1 to 2 years. Additionally, an incremental cortisol response at the first SST may be an important predictive factor of adrenal function recovery.

Citations

Citations to this article as recorded by  
  • Secondary Adrenal Insufficiency: Recent Updates and New Directions for Diagnosis and Management
    Lucinda M. Gruber, Irina Bancos
    Endocrine Practice.2022; 28(1): 110.     CrossRef
  • Oral corticosteroid elimination via a personalised reduction algorithm in adults with severe, eosinophilic asthma treated with benralizumab (PONENTE): a multicentre, open-label, single-arm study
    Andrew Menzies-Gow, Mark Gurnell, Liam G Heaney, Jonathan Corren, Elisabeth H Bel, Jorge Maspero, Timothy Harrison, David J Jackson, David Price, Njira Lugogo, James Kreindler, Annie Burden, Alex de Giorgio-Miller, Kelly Padilla, Ubaldo J Martin, Esther G
    The Lancet Respiratory Medicine.2022; 10(1): 47.     CrossRef
  • Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection
    Jia Wei Tan, Sachin K. Majumdar, Osamu Isozaki
    Case Reports in Endocrinology.2022; 2022: 1.     CrossRef
  • Long‐term corticosteroid use, adrenal insufficiency and the need for steroid‐sparing treatment in adult severe asthma
    M. Gurnell, L. G. Heaney, D. Price, A. Menzies‐Gow
    Journal of Internal Medicine.2021; 290(2): 240.     CrossRef
  • Glucocorticoid Withdrawal—An Overview on When and How to Diagnose Adrenal Insufficiency in Clinical Practice
    Katarzyna Pelewicz, Piotr Miśkiewicz
    Diagnostics.2021; 11(4): 728.     CrossRef
  • Morning Serum Cortisol as a Predictor for the HPA Axis Recovery in Cushing’s Disease
    Q. Cui, D. Liu, B. Xiang, Q. Sun, L. Fan, M. He, Y. Wang, X. Zhu, H. Ye, Giorgio Borretta
    International Journal of Endocrinology.2021; 2021: 1.     CrossRef
  • Dexamethasone-related adrenal insufficiency in patients with brain and skull base tumours
    H. Benghiat, P. Sanghera, D. Stange, P. Nightingale, A. Hartley, M.W O’Reilly, N. Nundall, H. Currie, M. Ali, G. Cruickshank, D. Spooner, A. Toogood
    Supportive Care in Cancer.2018; 26(12): 4031.     CrossRef
  • Articles inEndocrinology and Metabolismin 2016
    Won-Young Lee
    Endocrinology and Metabolism.2017; 32(1): 62.     CrossRef
  • The unresolved riddle of glucocorticoid withdrawal
    F. Guerrero Pérez, A. P. Marengo, C. Villabona Artero
    Journal of Endocrinological Investigation.2017; 40(11): 1175.     CrossRef
  • Lessons from iatrogenic Cushing syndrome in children
    Betty P Messazos, Margaret R Zacharin
    Journal of Paediatrics and Child Health.2016; 52(12): 1106.     CrossRef
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