Draoui Najat, Alla Achwak, Derkaoui Nada, Bouichrat Nisrine, Loukili Aymane, Rouf Siham, Latrech Hanane
Department of Endocrinology-Diabetology-Nutrition, Mohammed VI University Hospital, Medical School, Mohammed the First University, Oujda, Morocco.
Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed the First University, Morocco.
Ann Med Surg (Lond). 2022 May 7;78:103710. doi: 10.1016/j.amsu.2022.103710. eCollection 2022 Jun.
Long-term glucocorticoid (GC) use is the most frequent cause of adrenal insufficiency through suppression of the hypothalamic-pituitary-adrenal axis. There are no guidelines for predicting adrenal insufficiency (AI) and minimizing its risk.
This is a prospective observational study carried out in the Endocrinology-Diabetology and Nutrition department between 2014 and 2021. All patients had received GC therapy for longer than 3 weeks before switching to hydrocortisone substitution, for various indications. These patients were admitted to our department for stimulation tests. We assessed the prevalence of AI, predicting factors, screening and management.
In our study the GC-induced AI was found in 49% of patients. We found a strong correlation between the basal morning serum cortisol, body mass index and the peak cortisol level after stimulation tests, while no correlation was found between adrenal function and age, sex, indication of GC therapy, duration of corticosteroid therapy, cumulative dose and daily dose. Patients with GC induced AI took a mean of 12 ± 12,18 months to recover. Adrenal function recovery rate was higher in patients tested by short Synacthen than in those tested by Insulin Hypoglycemia.
We demonstrated the positive correlation between serum cortisol peak levels after stimulation and body mass index. The study supports that basal cortisol level, the duration of corticoid cessation and the type of stimulation test can predict the response of cortisol to stimulation tests.
长期使用糖皮质激素（GC）是通过抑制下丘脑 - 垂体 - 肾上腺轴导致肾上腺功能不全最常见的原因。目前尚无预测肾上腺功能不全（AI）并将其风险降至最低的指南。
这是一项于2014年至2021年在内分泌 - 糖尿病与营养科进行的前瞻性观察性研究。所有患者在改用氢化可的松替代治疗前均接受了超过3周的GC治疗，治疗适应证各不相同。这些患者被收入我科进行刺激试验。我们评估了AI的患病率、预测因素、筛查和管理情况。
在我们的研究中，49%的患者发现有GC诱导的AI。我们发现基础晨起血清皮质醇、体重指数与刺激试验后皮质醇峰值水平之间存在强相关性，而肾上腺功能与年龄、性别、GC治疗适应证、皮质类固醇治疗持续时间、累积剂量和每日剂量之间未发现相关性。GC诱导的AI患者平均需要12±12.18个月才能恢复。短程促肾上腺皮质激素试验检测的患者肾上腺功能恢复率高于胰岛素低血糖试验检测的患者。
我们证明了刺激后血清皮质醇峰值水平与体重指数之间呈正相关。该研究支持基础皮质醇水平、皮质激素停用持续时间和刺激试验类型可预测皮质醇对刺激试验的反应。
