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Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency

BACKGROUND: The chronic use of glucocorticoids (GC) suppresses function of the hypothalamic-pituitary-adrenal axis and often results in secondary adrenal insufficiency (AI). The present study aimed to determine the recovery rate of adrenal function in patients with secondary AI within 1 to 2 years a...

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Autores principales: Baek, Jong Ha, Kim, Soo Kyoung, Jung, Jung Hwa, Hahm, Jong Ryeal, Jung, Jaehoon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Endocrine Society 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803552/
https://www.ncbi.nlm.nih.gov/pubmed/26676337
http://dx.doi.org/10.3803/EnM.2016.31.1.153
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author Baek, Jong Ha
Kim, Soo Kyoung
Jung, Jung Hwa
Hahm, Jong Ryeal
Jung, Jaehoon
author_facet Baek, Jong Ha
Kim, Soo Kyoung
Jung, Jung Hwa
Hahm, Jong Ryeal
Jung, Jaehoon
author_sort Baek, Jong Ha
collection PubMed
description BACKGROUND: The chronic use of glucocorticoids (GC) suppresses function of the hypothalamic-pituitary-adrenal axis and often results in secondary adrenal insufficiency (AI). The present study aimed to determine the recovery rate of adrenal function in patients with secondary AI within 1 to 2 years and to assess the factors predictive of adrenal function recovery. METHODS: This was a retrospective observational study that enrolled patients diagnosed with GC-induced secondary AI between 2007 and 2013. AI was defined by peak serum cortisol levels <18 µg/dL during a standard-dose short synacthen test (SST). A follow-up SST was performed after 1 to 2 years, and responders were defined as those with adrenocorticotropic hormone (ACTH)-stimulated peak serum cortisol levels ≥18 µg/dL. RESULTS: Of the total 34 patients diagnosed with GC-induced secondary AI at first, 20 patients (58.8%) recovered normal adrenal function by the time of the follow-up SST (median follow-up period, 16.5 months). Although the baseline serum ACTH and cortisol levels at the first SST did not differ between responders and non-responders, the incremental cortisol response during the first SST was higher in responders than that of non-responders (7.88 vs. 3.56, P<0.01). Additionally, higher cortisol increments during the first SST were an independent predictive factor of the adrenal function recovery (odds ratio, 1.58; 95% confidence interval, 1.02 to 2.46; P<0.05). CONCLUSION: In the present study, adrenal function recovery was achieved frequently in patients with GC-induced secondary AI within 1 to 2 years. Additionally, an incremental cortisol response at the first SST may be an important predictive factor of adrenal function recovery.
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spelling pubmed-48035522016-03-27 Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency Baek, Jong Ha Kim, Soo Kyoung Jung, Jung Hwa Hahm, Jong Ryeal Jung, Jaehoon Endocrinol Metab (Seoul) Original Article BACKGROUND: The chronic use of glucocorticoids (GC) suppresses function of the hypothalamic-pituitary-adrenal axis and often results in secondary adrenal insufficiency (AI). The present study aimed to determine the recovery rate of adrenal function in patients with secondary AI within 1 to 2 years and to assess the factors predictive of adrenal function recovery. METHODS: This was a retrospective observational study that enrolled patients diagnosed with GC-induced secondary AI between 2007 and 2013. AI was defined by peak serum cortisol levels <18 µg/dL during a standard-dose short synacthen test (SST). A follow-up SST was performed after 1 to 2 years, and responders were defined as those with adrenocorticotropic hormone (ACTH)-stimulated peak serum cortisol levels ≥18 µg/dL. RESULTS: Of the total 34 patients diagnosed with GC-induced secondary AI at first, 20 patients (58.8%) recovered normal adrenal function by the time of the follow-up SST (median follow-up period, 16.5 months). Although the baseline serum ACTH and cortisol levels at the first SST did not differ between responders and non-responders, the incremental cortisol response during the first SST was higher in responders than that of non-responders (7.88 vs. 3.56, P<0.01). Additionally, higher cortisol increments during the first SST were an independent predictive factor of the adrenal function recovery (odds ratio, 1.58; 95% confidence interval, 1.02 to 2.46; P<0.05). CONCLUSION: In the present study, adrenal function recovery was achieved frequently in patients with GC-induced secondary AI within 1 to 2 years. Additionally, an incremental cortisol response at the first SST may be an important predictive factor of adrenal function recovery. Korean Endocrine Society 2016-03 2016-03-16 /pmc/articles/PMC4803552/ /pubmed/26676337 http://dx.doi.org/10.3803/EnM.2016.31.1.153 Text en Copyright © 2016 Korean Endocrine Society http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Baek, Jong Ha
Kim, Soo Kyoung
Jung, Jung Hwa
Hahm, Jong Ryeal
Jung, Jaehoon
Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency
title Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency
title_full Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency
title_fullStr Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency
title_full_unstemmed Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency
title_short Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency
title_sort recovery of adrenal function in patients with glucocorticoids induced secondary adrenal insufficiency
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803552/
https://www.ncbi.nlm.nih.gov/pubmed/26676337
http://dx.doi.org/10.3803/EnM.2016.31.1.153
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