Ema
Senior Member
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So many times we hear stories about permanent suppression of the adrenals after taking steroids as a reason to deny those with "marginal" stim test results access to HC replacement treatment along the lines of OMG, you will wreck your adrenals forever!
This article shows that it can take up to 3 years, but only 5% of people never recover adrenal function. And they were likely AI to begin with...so this fear should not be a reason to deny a person with borderline labs and clinical low cortisol symptoms a therapeutic trial of HC.
At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients.
PLoS One. 2013 Jul 24;8(7):e68713. doi: 10.1371/journal.pone.0068713. Print 2013.
Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study.
Jamilloux Y1, Liozon E, Pugnet G, Nadalon S, Heang Ly K, Dumonteil S, Gondran G, Fauchais AL, Vidal E.
Author information
Abstract
OBJECTIVES:
Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency.
SUBJECTS AND DESIGN:
150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared.
RESULTS:
At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05).
CONCLUSION:
Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians' vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.
PMID:
23894335
[PubMed - indexed for MEDLINE]
PMCID:
PMC3722149
Free PMC Article
This article shows that it can take up to 3 years, but only 5% of people never recover adrenal function. And they were likely AI to begin with...so this fear should not be a reason to deny a person with borderline labs and clinical low cortisol symptoms a therapeutic trial of HC.
At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients.
PLoS One. 2013 Jul 24;8(7):e68713. doi: 10.1371/journal.pone.0068713. Print 2013.
Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study.
Jamilloux Y1, Liozon E, Pugnet G, Nadalon S, Heang Ly K, Dumonteil S, Gondran G, Fauchais AL, Vidal E.
Author information
Abstract
OBJECTIVES:
Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency.
SUBJECTS AND DESIGN:
150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared.
RESULTS:
At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05).
CONCLUSION:
Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians' vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.
PMID:
23894335
[PubMed - indexed for MEDLINE]
PMCID:
PMC3722149
Free PMC Article