Endocrinol Metab.  2016 Mar;31(1):153-160. 10.3803/EnM.2016.31.1.153.

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

• Baek JH
• Kim SK
• Jung JH
• Hahm JR
• Jung J

• KMID: 2169707
• DOI: http://doi.org/10.3803/EnM.2016.31.1.153

Abstract

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.

Keyword

Adrenal insufficiency; Glucocorticoids; Recovery; Predictive factor

MeSH Terms

Adrenal Insufficiency*
Adrenocorticotropic Hormone
Axis
Follow-Up Studies
Glucocorticoids*
Humans
Hydrocortisone
Observational Study
Recovery of Function
Retrospective Studies
Adrenocorticotropic Hormone
Glucocorticoids
Hydrocortisone

Figure

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  Fig. 1 Subject enrollment. TSA, transshenoidal approach; ACC, adrenal cortical carcinoma; SST, short synacthen test; HPA, hypothalamic-pituitary-adrenal.

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  Fig. 2 The area under the receiver operating characteristic curve to assess the ability of the serum cortisol increment (delta cortisol) to predict the hypothalamic-pituitary-adrenal axis recovery after the first short synacthen test. A peak cortisol cut-off of ≥8.15 µg/dL gives a sensitivity of 50% and a specificity of 79%, and that of ≥8.99 µg/dL gives a sensitivity of 40% and a specificity of 86% for predicting adrenal function recovery.

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