Endocrine Abstracts

Introduction: Prolonged therapy (≥ 3 months) with high-dose corticosteroids (≥ 7.5 mg Prednisolone or 1–1.5 mg Dexamethasone daily) can result in adrenal atrophy and secondary adrenal failure. Abrupt withdrawal of corticosteroids after prolonged use can lead to adrenal insufficiency, corticosteroid withdrawal symptoms or a relapse of the initial disease. A safe flexible management plan is required for each patient. We illustrate with two cases.

Case 1: A 68 year old lady presents with a 2 month history of tiredness and generalised body aches. She had been on high-dose (20–40 mg) Prednisolone for polymyalgia rheumatic for over 2 years. Her Prednisolone dose had been rapidly tailed down to 5 mg daily while she remained asymptomatic, and then by 1 mg monthly until she settled on 2 mg daily. She was referred to the endocrine department and a short Synacthen test revealed adrenal insufficiency. She is now asymptomatic after her Prednisolone dose was increased to 5 mg daily.

Case 2: A 63 year old man was referred for assessment of adrenal function. He had been on high-dose (20 mg) Prednisolone along with Etoricoxib and Hydroxychloroquine for polymyalgia rheumatica and seropositive rheumatoid arthritis for over 3 years. The Prednisolone dose was tailed down fairly quickly to 7.5 mg daily then gradually by 0.5 mg monthly until he settled on 3 mg daily. After a weekend conversion to Hydrocortisone 5 mg twice a day, a short Synacthen test revealed adequate adrenal function. He continued tailing down the Prednisolone dose until stopping it, but because of ongoing rheumatology symptoms Methotrexate was added to his treatment and he remains well.

Conclusion: Our protocol ensures patients are informed of the problems that may be encountered during corticosteroid withdrawal after prolonged use, a safe and flexible corticosteroid withdrawal regimen, and that regular adrenal function assessment is carried out during and after successful corticosteroid withdrawal.