Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Division of Endocrinology, Department of Medicine, Leiden University Medical Centre, ZA Leiden, the Netherlands.
Eur J Endocrinol. 2021 Apr;184(4):R111-R122. doi: 10.1530/EJE-20-1199.
Glucocorticoids are, besides non-steroidal anti-inflammatory drugs, the most widely used anti-inflammatory medications. Prevalence studies indicate substantial use of both systemic and locally acting agents. A recognised adverse effect of glucocorticoid treatment is adrenal insufficiency, which is highly prevalent based on biochemical testing, but its clinical implications are poorly understood. Current evidence, including randomised trials and observational studies, indicates substantial variation among patients in both risk and course of glucocorticoid-induced adrenal insufficiency, but both are currently unpredictable. Oral and intra-articular formulations, as well as long-term and high-dose treatments, carry the highest risk of glucocorticoid-induced adrenal insufficiency defined by biochemical tests. However, no route of administration, treatment duration, or dose can be considered without risk. More research is needed to estimate the risk and temporal pattern of glucocorticoid-induced adrenal insufficiency, to investigate its clinical implications, and to identify predictors of risk and prognosis. Randomized trials are required to evaluate whether hydrocortisone replacement therapy mitigates risk and symptoms of glucocorticoid-induced adrenal insufficiency in patients discontinuing glucocorticoid treatment. This review aims to provide an overview of the available evidence, pointing to knowledge gaps and unmet needs.
糖皮质激素是除非甾体抗炎药外应用最广泛的抗炎药物。流行性病学研究表明，全身用和局部用制剂的应用都很广泛。糖皮质激素治疗的一个公认的不良反应是肾上腺功能不全，基于生化检测，其患病率很高，但对其临床意义了解甚少。目前的证据，包括随机试验和观察性研究，表明患者在糖皮质激素诱导的肾上腺功能不全的风险和病程方面存在很大差异，但目前都无法预测。口服和关节内制剂，以及长期和高剂量治疗，发生由生化检测定义的糖皮质激素诱导的肾上腺功能不全的风险最高。然而，没有任何一种给药途径、治疗持续时间或剂量可以被认为是没有风险的。需要更多的研究来估计糖皮质激素诱导的肾上腺功能不全的风险和时间模式，研究其临床意义，并确定风险和预后的预测因素。需要进行随机试验来评估氢化可的松替代疗法是否可以减轻停止糖皮质激素治疗的患者的糖皮质激素诱导的肾上腺功能不全的风险和症状。本综述旨在概述现有证据，指出知识空白和未满足的需求。
