Mori M
Nihon Naibunpi Gakkai Zasshi. 1978 Jan 20;54(1):54-67. doi: 10.1507/endocrine1927.54.1_54.
The present study was undertaken to investigate suppression of the pituitary-adrenocortical function by long-term corticosteroid therapy and spontaneous recovery from such a suppressant drug effect. Sixty patients who were on corticosteroids (hereinafter their dosage is expressed as the equivalent of prednisolone) given at 10 to 40 mg initially and then on a gradually decreasing basis down to below 10 mg currently or who had already been withdrawn from such a drug regimen were involved in the study and analysed for baseline values for plasma cortisol. These patients were evaluated for the functional status of the pituitary-adrenocortical system in relation to varying combinations of such factors as the total dose of corticosteroids, the duration in days of medication, the duration in days of mecication at reduced dosage levels, and time in days elapsed from cessation of medication. The results led to the following conclusions: (1) In patients receiving corticosteroids at such daily dosage levels as are reduced gradually to 7.5 mg or below within the duration in days as defined by the inequality Y greater than or equal to 8.4X + 222 (where Y stands for total dose given and X stands for the duration in days of administration), the pituitary-adrenocortical function is assumed to be in a state of being suppressed. When corticosteroids have been given at daily dosages reduced gradually to 7.5 mg or below within the duration in days as determined by the inequality Y less than or equal to 6.8X + 140 (where Y and X, respectively, stand as mentioned above), the pituitary-adrenocortical function of the recipient patient is considered to be in a state either of being not suppressed or of being recovered from suppressant drug effect. (2) In cases where corticosteroid therapy is started with a moderate dosage, then reduced to a low dosage level or stopped within relatively short period of time, the recipient patient can be safely withdrawn from the drug therapy without suppression of the pituitary-adrenocortical function if the dosage schedule is in line with the inequality Y less than or equal to 5.9X + 331 (where X denotes the duration in days of medication and Y, total dose). These results led the author to formulate a model of a corticosteroid dosage schedule which is reasonable free from the risk of causing pituitary-adrenocortical insufficiency. More particularly, the dosage of corticosteroids is reduced by a 5 mg decrement at regular intervals of 5, 8, 13, 27 and 103 days, respectively, when the initial daily dose is 30, 25, 20, 15 and 10 mg. By following this dosage regimen one might expect safe withdrawal from corticosteroid therapy without risking suppression of the pituitary-adrenocortical function. (3) Corticosteroid therapy, when given at a dosage of 7.5 mg or less daily, is considered to have little suppressant effect on the pituitary-adrenocortical function...
本研究旨在调查长期使用皮质类固醇疗法对垂体 - 肾上腺皮质功能的抑制作用以及这种抑制药物效应的自发恢复情况。60例正在接受皮质类固醇治疗的患者（以下其剂量以泼尼松龙等效剂量表示）参与了研究，这些患者最初服用剂量为10至40mg，随后逐渐减量至目前低于10mg，或者已经停用此类药物治疗方案，对他们进行血浆皮质醇基线值分析。根据皮质类固醇的总剂量、用药天数、减量用药天数以及停药后经过的天数等不同因素组合，对这些患者的垂体 - 肾上腺皮质系统功能状态进行评估。结果得出以下结论：（1）在接受皮质类固醇治疗的患者中，若在由不等式Y≥8.4X + 222（其中Y代表总给药剂量，X代表给药天数）所定义的天数内，每日剂量逐渐减至7.5mg或更低，则垂体 - 肾上腺皮质功能被认为处于受抑制状态。当皮质类固醇在由不等式Y≤6.8X + 140（其中Y和X如上所述）所确定的天数内，每日剂量逐渐减至7.5mg或更低时，接受治疗患者的垂体 - 肾上腺皮质功能被认为处于未受抑制状态或已从抑制药物效应中恢复。（2）在以中等剂量开始皮质类固醇治疗，然后在相对较短时间内减至低剂量水平或停药的情况下，如果给药方案符合不等式Y≤5.9X + 331（其中X表示用药天数，Y表示总剂量），则接受治疗的患者可以安全停药而不会抑制垂体 - 肾上腺皮质功能。这些结果促使作者制定了一种合理的、无导致垂体 - 肾上腺皮质功能不全风险的皮质类固醇给药方案模型。更具体地说，当初始日剂量为30mg、25mg、20mg、15mg和10mg时，皮质类固醇剂量分别在5天、8天、13天、27天和103天的固定间隔内每次减少5mg。遵循此给药方案，有望安全停用皮质类固醇治疗而不会有抑制垂体 - 肾上腺皮质功能的风险。（3）每日剂量为7.5mg或更低的皮质类固醇治疗，被认为对垂体 - 肾上腺皮质功能几乎没有抑制作用……
