Henzen C, Suter A, Lerch E, Urbinelli R, Schorno X H, Briner V A
Department of Medicine, Kantonsspital Lucerne, Switzerland.
Lancet. 2000 Feb 12;355(9203):542-5. doi: 10.1016/S0140-6736(99)06290-X.
Suppression of the adrenal response is an unpredictable consequence of glucocorticoid treatment. To investigate the kinetics of the adrenal response after short-term, high-dose glucocorticoid treatment, we measured the adrenal response to the low-dose (1 microg) corticotropin stimulation test.
We studied 75 patients who received the equivalent of at least 25 mg prednisone daily for between 5 days and 30 days. After discontinuation of glucocorticoid treatment, 1 microg corticotropin was administered intravenously, and stimulated plasma cortisol concentrations were measured 30 min later. In patients with a suppressed response to 1 microg corticotropin, the test was repeated until stimulated plasma cortisol concentrations reached the normal range.
The adrenal response to 1 microg corticotropin was suppressed in 34 patients and normal in 41. Subsequent low-dose corticotropin tests showed a steady recovery of the adrenal response within 14 days. In two patients, the adrenal response remained suppressed for several months. There was no correlation between plasma cortisol concentrations and the duration or dose of glucocorticoid treatment.
Suppression of the adrenal response is common after short-term, high-dose glucocorticoid treatment. The low-dose corticotropin test is a sensitive and simple test to assess the adrenal response after such treatment.
肾上腺反应受抑制是糖皮质激素治疗不可预测的后果。为了研究短期、大剂量糖皮质激素治疗后肾上腺反应的动力学，我们测量了肾上腺对低剂量（1微克）促肾上腺皮质激素刺激试验的反应。
我们研究了75例患者，他们每日接受相当于至少25毫克泼尼松的药物治疗，持续5天至30天。停用糖皮质激素治疗后，静脉注射1微克促肾上腺皮质激素，30分钟后测量刺激后的血浆皮质醇浓度。对于对1微克促肾上腺皮质激素反应受抑制的患者，重复该试验，直到刺激后的血浆皮质醇浓度达到正常范围。
34例患者对1微克促肾上腺皮质激素的肾上腺反应受抑制，41例正常。随后的低剂量促肾上腺皮质激素试验显示，肾上腺反应在14天内稳步恢复。2例患者的肾上腺反应持续受抑制数月。血浆皮质醇浓度与糖皮质激素治疗的持续时间或剂量之间无相关性。
短期、大剂量糖皮质激素治疗后，肾上腺反应受抑制很常见。低剂量促肾上腺皮质激素试验是评估此类治疗后肾上腺反应的一种敏感且简单的试验。
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