1. Adrenal insufficiency in prednisolone-treated patients with polymyalgia rheumatica or giant cell arteritis-prevalence and clinical approach.
- Author
-
Borresen SW, Thorgrimsen TB, Jensen B, Hilsted L, Bartels EM, Feldt-Rasmussen U, and Locht H
- Subjects
- Adrenal Insufficiency blood, Adrenal Insufficiency drug therapy, Adrenal Insufficiency epidemiology, Adrenocorticotropic Hormone analysis, Adrenocorticotropic Hormone drug effects, Aged, Aged, 80 and over, Anti-Inflammatory Agents therapeutic use, Case-Control Studies, Denmark epidemiology, Female, Follow-Up Studies, Glucocorticoids adverse effects, Glucocorticoids therapeutic use, Humans, Hydrocortisone therapeutic use, Male, Middle Aged, Prednisolone therapeutic use, Prevalence, Adrenal Insufficiency chemically induced, Giant Cell Arteritis drug therapy, Polymyalgia Rheumatica drug therapy, Prednisolone adverse effects
- Abstract
Objectives: Glucocorticoid treatment is fundamental in polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), but carries a risk of glucocorticoid-induced adrenal insufficiency. Adrenal insufficiency can cause reluctance to stop glucocorticoid treatment after disease remission as symptoms can resemble PMR/GCA flare. We aimed to determine the prevalence of adrenal insufficiency in prednisolone-treated patients with PMR/GCA., Methods: We included 47 patients with PMR (n = 37), GCA (n = 1) or both (n = 9), treated with prednisolone for ≥5.4 months, current dose 2.5-10 mg/day. Adrenal function was evaluated using a corticotropin (Synacthen®) stimulation test following 48 h prednisolone pause. Two years' clinical follow-up data are provided., Results: Seven patients (15%) had adrenal insufficiency, 4 (11%) of the 37 patients with PMR alone, and 3 (30%) of the 10 patients with GCA. Corticotropin-stimulated P-cortisol was significantly associated with current prednisolone dose, mean daily dose the last 3 and 6 months before testing, and basal P-cortisol, but not with total dose or treatment duration. Adrenal insufficiency occurred with all current prednisolone doses (2.5-10 mg/day). Five (71%) of the glucocorticoid-insufficient patients could discontinue prednisolone treatment; two of them recovered glucocorticoid function, whereas three still needed hydrocortisone replacement 2 years later. Two patients experienced in total four acute hospital admissions with symptoms of adrenal crises., Conclusion: Glucocorticoid-induced adrenal insufficiency occurred in 15% of patients with PMR/GCA. Mean prednisolone dose the last 3 months and basal P-cortisol were the best and simplest predictors of adrenal function. Most of the glucocorticoid-insufficient patients could discontinue prednisolone with appropriate treatment for adrenal insufficiency., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
- Full Text
- View/download PDF