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Endocrine Abstracts (2018) 56 P44 | DOI: 10.1530/endoabs.56.P44

Leeds Centre for Diabetes and Endocrinology, St James’ University Hospital, Leeds Teaching Hospitals, Leeds, UK.


Background: Prolonged, high dose glucocorticoid therapy is used in to treat a number of rheumatological diseases, including polymyalgia rheumatica (PMR), giant-cell arteritis (GCA) and large vessel vasculitis (LVV). However there can be significant consequences of long-term glucocorticoid use, including iatrogenic adrenal insufficiency, due to suppression of the hypothalamic-pituitary-adrenal axis. This study aims to evaluate the prevalence, investigation and recovery of iatrogenic adrenal insufficiency in patients with PMR, GCA and LVV at a large UK teaching hospital.

Methods: We retrospectively identified patients seen in rheumatology outpatient clinics with a diagnosis of PMR, GCA or LVV, who had cortisol levels or short synacthen tests (SST) performed, between January 2014 and November 2017. Data were collected using a standardised proforma which included demographics, co-morbidities, maximal glucocorticoid dose and duration, clinical symptoms and details of investigations for adrenal insufficiency (i.e. SST results or cortisol values).

Results: We evaluated a total of 95 patients. The mean duration of prednisolone use was 4 years, 3 months (range 11–204 months). Over 30% of patients used a peak dose of prednisolone greater than or equal to 40 mg. 72% of all patients had symptoms possibly consistent with adrenal insufficiency. In total, eighty patients had a SST, mostly via the rheumatology department. On retrospective review of the SST results by a consultant endocrinologist, 33% of all tests were found to have sub-optimal cortisol levels. However 17.5% of baseline SSTs were not conducted appropriately. Of the patients who were found to have abnormal results, only 35% went on to have a repeat SST. 54% of the repeat SSTs showed normal adrenal function. Of the asymptomatic patients, 51.9% (n=14) had baseline tests consistent with adrenal insufficiency. The mean time to adrenal recovery overall, from baseline test was 18 months. 18% of patients with evidence of adrenal insufficiency had their prednisolone switched to a shorter acting glucocorticoid. Despite having an abnormal SST result, 43% patients were not referred to an endocrinologist.

Conclusion: Our study suggests there is a high prevalence of adrenal insufficiency in both symptomatic and asymptomatic groups in this patient population. The vast majority of patients with abnormal SST results did not have suitable follow-up tests and a large proportion were not referred to endocrinology. These results suggest the need for a joint pathway of care for evaluation of adrenal insufficiency in this patient group. Further studies, evaluating the optimal intervention strategies to aid adrenal recovery are also needed.

Volume 56

20th European Congress of Endocrinology

Barcelona, Spain
19 May 2018 - 22 May 2018

European Society of Endocrinology 

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