Endocrine Abstracts

Introduction

Adrenal insufficiency is the most common complication after long-term corticosteroid therapy, to affirm or exclude the diagnosis of adrenal insufficiency several authors suggest basal cortisol testing as first-line, however, others prefer stimulating tests (insulin hypoglycemia (IGH) or synacthen testing). The aim of our work is to Analyze the frequency and determinant of the biological adrenal insufficiency detected by stimulating tests.

Material and methods

This is a retrospective study concerning 27 patients, who have taken long-term corticosteroid therapy at doses higher than 7.5 mg/day stopped and hydrocortisone relayed at variable doses, 49 tests were performed. over a 6-year time period.

Results

The mean age was 41.4 ± 14.6 years, mean duration of corticosteroid therapy was 27.7 ± 45 months, the cortisol limit for exploration by a dynamic test was reached after an average of 15 months in 45% of cases. 63% of patients did not respond to the test, with a mean cortisol level of 13.7 ng/l, and 37% responded to the stimulation test, with a mean cortisol level of 20.1 ng/l. Half of these responder patients were tested by Synacthen 250 mg immediate and half with IGH.

Discussion-conclusion

Follow-up of patients after prolonged corticosteroid therapy allows to predicts the ideal time to perform corticotropic axis stimulation tests and then to stop or maintain hydrocortisone substitution, it also prevents acute adrenal insufficiency.