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Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study.

Jamilloux Y, Liozon E, Pugnet G, Nadalon S, Heang Ly K, Dumonteil S, Gondran G, Fauchais AL, Vidal E - PLoS ONE (2013)

Bottom Line: 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).Thus, physicians' vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Limoges University Hospital, Limoges, France. yvanjamilloux@hotmail.com

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.

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Related in: MedlinePlus

Flow chart of the study population.GCA: giant cell arteritis, T1 to T4: ACTH tests 1–4.
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pone-0068713-g001: Flow chart of the study population.GCA: giant cell arteritis, T1 to T4: ACTH tests 1–4.

Mentions: Seventy-four (49%) non-responders to the first ACTH stimulation test were re-evaluated annually until they had fully recovered. The patients’ outcomes are shown in Figure 1. Nineteen patients were lost to follow-up during the study, four patients voluntarily stopped the hormone substitution, two patients died (unrelated to GCA) and one patient relapsed.


Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study.

Jamilloux Y, Liozon E, Pugnet G, Nadalon S, Heang Ly K, Dumonteil S, Gondran G, Fauchais AL, Vidal E - PLoS ONE (2013)

Flow chart of the study population.GCA: giant cell arteritis, T1 to T4: ACTH tests 1–4.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3722149&req=5

pone-0068713-g001: Flow chart of the study population.GCA: giant cell arteritis, T1 to T4: ACTH tests 1–4.
Mentions: Seventy-four (49%) non-responders to the first ACTH stimulation test were re-evaluated annually until they had fully recovered. The patients’ outcomes are shown in Figure 1. Nineteen patients were lost to follow-up during the study, four patients voluntarily stopped the hormone substitution, two patients died (unrelated to GCA) and one patient relapsed.

Bottom Line: 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).Thus, physicians' vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Limoges University Hospital, Limoges, France. yvanjamilloux@hotmail.com

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.

Show MeSH
Related in: MedlinePlus