KES
Search
- Page Path
- HOME > Search
Original Articles
- Clinical Study
- The Recovery of Hypothalamic-Pituitary-Adrenal Axis Is Rapid in Subclinical Cushing Syndrome
- Hee Kyung Kim, Jee Hee Yoon, Yun Ah Jeong, Ho-Cheol Kang
- Endocrinol Metab. 2016;31(4):592-597. Published online December 20, 2016
- DOI: https://doi.org/10.3803/EnM.2016.31.4.592
- 3,656 View
- 45 Download
- 8 Web of Science
- 8 Crossref
-
Abstract
PDF
PubReader Background In subclinical Cushing syndrome (SC), it is assumed that glucocorticoid production is insufficient to cause a clinically recognizable syndrome. Differences in hormonal levels or recovery time of the hypothalamic-pituitary-adrenocortical (HPA) axis after adrenalectomy between patients with overt Cushing syndrome (OC) and SC remain unknown.
Methods Thirty-six patients (10 with OC and 26 with SC) with adrenal Cushing syndrome who underwent adrenalectomy from 2004 to 2014 were reviewed retrospectively. Patients were treated with glucocorticoid after adrenalectomy and were reevaluated every 1 to 6 months using a rapid adrenocorticotropic hormone (ACTH) stimulation test.
Results Levels of basal 24-hour urine free cortisol (UFC), serum cortisol after an overnight dexamethasone suppression test (DST), and serum cortisol and 24-hour UFC after low-dose DST and high-dose DST were all significantly lower in patients with SC compared with OC. Basal ACTH levels showed significantly higher in patients with SC compared with OC. The probability of recovering adrenal function during follow-up differed significantly between patients with OC and SC (
P =0.001), with significant correlations with the degree of preoperative cortisol excess. Patients with OC required a longer duration of glucocorticoid replacement to recover a normal ACTH stimulation test compared with patients with SC (median 17.0 months vs. 4.0 months,P <0.001).Conclusion The HPA axis recovery time after adrenalectomy in patients with SC is rapid and is dependent on the degree of cortisol excess. More precise definition of SC is necessary to achieve a better management of patients and to avoid the risk of under- or over-treatment of SC patients.
-
Citations
Citations to this article as recorded by
- Hypothalamic–pituitary–adrenal axis recovery after treatment of Cushing's syndrome
Annemarie Balasko, Karin Zibar Tomsic, Darko Kastelan, Tina Dusek
Journal of Neuroendocrinology.2022;[Epub] CrossRef - Early assessment of postoperative adrenal function is necessary after adrenalectomy for mild autonomous cortisol secretion
Trenton Foster, Irina Bancos, Travis McKenzie, Benzon Dy, Geoffrey Thompson, Melanie Lyden
Surgery.2021; 169(1): 150. CrossRef - Is Prophylactic Steroid Treatment Mandatory for Subclinical Cushing Syndrome After Unilateral Laparoscopic Adrenalectomy?
Dong Wang, Han-zhong Li, Yu-shi Zhang, Liang Wang, Zhi-gang Ji
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(1): 31. CrossRef - When to Intervene for Subclinical Cushing's Syndrome
Lily B. Hsieh, Erin Mackinney, Tracy S. Wang
Surgical Clinics of North America.2019; 99(4): 747. CrossRef - Serum Cortisol Levels via Radioimmunoassay vs Liquid Chromatography Mass Spectrophotometry in Healthy Control Subjects and Patients With Adrenal Incidentalomas
Martha K P Huayllas, Brian C Netzel, Ravinder J Singh, Claudio E Kater
Laboratory Medicine.2018;[Epub] CrossRef - Contralateral adrenal width predicts the duration of prolonged post‐surgical steroid replacement for subclinical Cushing syndrome
Masahiro Sugiura, Yusuke Imamura, Koji Kawamura, Satoshi Yamamoto, Tomokazu Sazuka, Kazuyoshi Nakamura, Shinichi Sakamoto, Hidekazu Nagano, Hisashi Koide, Tomoaki Tanaka, Takashi Imamoto, Akira Komiya, Tomohiko Ichikawa
International Journal of Urology.2018; 25(6): 583. CrossRef - Predictability of hypoadrenalism occurrence and duration after adrenalectomy for ACTH-independent hypercortisolism
V. Morelli, L. Minelli, C. Eller-Vainicher, S. Palmieri, E. Cairoli, A. Spada, M. Arosio, I. Chiodini
Journal of Endocrinological Investigation.2018; 41(4): 485. CrossRef - Articles inEndocrinology and Metabolismin 2016
Won-Young Lee
Endocrinology and Metabolism.2017; 32(1): 62. CrossRef
- Hypothalamic–pituitary–adrenal axis recovery after treatment of Cushing's syndrome
- 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
- 4,918 View
- 81 Download
- 11 Web of Science
- 10 Crossref
-
Abstract
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
- Secondary Adrenal Insufficiency: Recent Updates and New Directions for Diagnosis and Management
First
Prev
