SFEBES2023 Poster Presentations Adrenal and Cardiovascular (78 abstracts)
Weaning patients off long-term low dose (5mg) prednisolone: A national survey of current endocrine practice
Katharine Lazarus 1,2 , Kavita Narula 1,2 , Sirazum Choudhury 1,2,3 , Niamh Martin 1,2 , Florian Wernig 2 , Deborah Papadopoulou 2 , Tricia Tan 1,2,3 , Yasir S Elhassan 4,5 , Anna L Mitchell 6 , Helen Simpson 7 , Jessica Davies 8 , Roisin Evans 8 , Katherine Single 8 & Karim Meeran 1,2
1Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom. 2Department of Endocrinology, Imperial College Healthcare NHS Trust, London, United Kingdom. 3Department of Clinical Biochemistry, Northwest London Pathology, London, United Kingdom. 4Department of Endocrinology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. 5Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom. 6Royal Victoria Infirmary, Newcastle upon Tyne NHS Hospitals Trust, Newcastle, United Kingdom. 7Department of Diabetes and Endocrinology, University College London Hospital, London, United Kingdom. 8Society for Endocrinology, Bristol, United Kingdom
Background: Prolonged glucocorticoid use is associated with significant morbidity and mortality, including the development of glucocorticoid-induced adrenal insufficiency (GI-AI). There is no consensus regarding glucocorticoid weaning (<5mg prednisolone-equivalent dose) to alleviate withdrawal symptoms while promoting the quickest adrenal axis recovery. There is also limited research into understanding current practice and the barriers to weaning.
Aim: To establish how long-term glucocorticoid weaning is currently managed by UK endocrinologists.
Methods: An anonymous online survey was disseminated to all clinical members of the Society for Endocrinology between 15/05/2023 and 22/06/2023.
Results: 163 responded to the survey (66.7% consultants, 14.7% specialty trainees, 11.5% endocrine specialist nurses, 7.1% other). Approaches to managing GI-AI were very heterogeneous. Respondents were asked how they would investigate and manage a patient, with a 9am cortisol of 98 nmol/l, no longer requiring long-term prednisolone for asthma. 54% of respondents opted for a short synacthen test whilst on 5mg prednisolone; 33% would not investigate whilst on this dose but would wean further first; 11% would not investigate further at all. When managing patients, 60.5% opt to switch to hydrocortisone (39.5% continue prednisolone) and 75% favoured weaning slowly. 17.9% continue life-long replacement glucocorticoid without further investigation, the majority favouring replacement hydrocortisone. 62.1% of respondents did not have a local steroid weaning protocol. Over half (53.4%) would not consider discharging the patient from endocrinology follow-up until weaned off prednisolone. Over half of those (52.5%) would follow-up six-monthly. The commonest perceived cause for weaning failure was relapse of the underlying condition (58.2%) while 20.3% felt that glucocorticoid withdrawal symptoms hindered weaning. 16.5% reported that biochemically confirmed adrenal axis suppression on prednisolone led to a clinical decision not to pursue further steroid weaning.
Discussion: There is huge variation in the management of long-term glucocorticoid weaning, with a clear need to develop evidence-based steroid weaning pathways.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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