ECE2015 Eposter Presentations Adrenal cortex (94 abstracts)
Adrenal insufficiency during prednisolone treatment: need for cortisol replacement strategies in patients on long-term low-dose glucocorticoid treatment?
Stina Willemoes Borresen 1 , Bo Baslund 3 , Marianne Klose 1 , Æse Krogh Rasmussen 1 , Lennart Friis-Hansen 2 , Linda Hilsted 2 , Henning Locht 4 , Annette Hansen 5 , Merete Lund Hetland 6 & Ulla Feldt-Rasmussen 1
1Department of Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 2Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 3Department of Rheumatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 4Department of Rheumatology, Copenhagen University Hospital, Frederiksberg Hospital, Copenhagen, Denmark; 5Department of Rheumatology, Copenhagen University Hospital, Gentofte Hospital, Copenhagen, Denmark; 6Department of Rheumatology, Copenhagen University Hospital, Glostrup Hospital, Copenhagen, Denmark.
Background: Patients on long-term glucocorticoid treatment are at risk of adrenal insufficiency during glucocorticoid treatment. The side effect can occur during glucocorticoid treatment if there is a mismatch between glucocorticoid requirements and production/intake. High-dose glucocorticoid treatment is often sufficient to overcome most stressful situations. A low-dose of 5 mg prednisolone/day is however, equivalent to 20 mg hydrocortisone, a dose often used as basal glucocorticoid replacement in adrenal insufficiency. Contrary to patients in replacement therapy for adrenal insufficiency, patients treated with long-term low-dose glucocorticoids for various reasons are often not instructed in self-administration of supplemental doses in stressful situations.
Objective: We aimed to assess the prevalence of adrenal insufficiency in patients treated with 5 mg prednisolone/day.
Subjects and measures: As part of a larger study, 37 patients with rheumatoid arthritis (26 women, aged 36–85 years) treated with 5 mg prednisolone/day for at least 6 months (mean 108, range 6–336 months) had a 250 μg Synacthen test performed, after mean prednisolone pause of 47 h (range 36–96 h). P-cortisol was measured before and 30 min after Synacthen injection. Cut-off for normal adrenal function was 30 min P-cortisol >500 nmol/l as this is validated for our local cortisol assay. As a cut-off of 550 nmol/l is often used these data are also shown.
Results: Of the 37 patients 11 (30%) had an insufficient adrenal response to the Synacthen test. Using cut-off of 550 nmol/l 16/37 (43%) had adrenal insufficiency.
Conclusion: We found adrenal insufficiency in approximately one third of patients treated with 5 mg prednisolone/day. Since prednisolone treatment is often sustained for years in these patients, adrenal suppression is likely equally prolonged. Our findings raise the question whether a Synacthen test should be routinely performed in patients on long-term low-dose glucocorticoid treatment and insufficient patients handled with the same cortisol replacement strategies as other patients with verified adrenal insufficiency.
Disclosure: This study was supported by the Eva Maduras Foundation.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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