Department of Endocrinology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
J Endocrinol Invest. 2017 Nov;40(11):1175-1181. doi: 10.1007/s40618-017-0691-1. Epub 2017 May 20.
Glucocorticoid (GC) therapy is the most common cause of adrenal insufficiency (AI). The real prevalence of AI after GC is unknown but it could involve more than 30% of patients. Some gene variation has been associated with the variability of hypothalamic-pituitary-adrenal (HPA) axis and this issue could contribute to the individual variation of adrenal function after GC treatment. Symptoms and signs of AI are nonspecific and frequently the diagnosis is delayed. Dosage, duration of treatment, administration route and serum cortisol value are not completely useful to predict AI. Clinical estimation of HPA suppression is difficult and biochemical testing is needed to confirm the diagnosis of AI. The different tapering regimens are based on a very low quality of evidence and considering the sizable individual variation, it is improbable that future research will find a secure GC tapering schedule for all patients. The aim of this review is to address the most important aspects in management of GC withdrawal in light of current knowledge.
糖皮质激素（GC）治疗是导致肾上腺皮质功能不全（AI）最常见的原因。GC 治疗后 AI 的真实患病率尚不清楚，但可能涉及超过 30%的患者。一些基因变异与下丘脑-垂体-肾上腺（HPA）轴的变异性有关，这个问题可能导致 GC 治疗后肾上腺功能的个体差异。AI 的症状和体征是非特异性的，且常常诊断被延迟。剂量、治疗持续时间、给药途径和血清皮质醇值并不能完全预测 AI。HPA 抑制的临床评估很困难，需要进行生化检测以确诊 AI。不同的逐渐减量方案基于非常低质量的证据，而且考虑到个体差异较大，未来的研究不太可能为所有患者找到安全的 GC 逐渐减量方案。本综述的目的是根据现有知识，探讨 GC 停药管理的最重要方面。
