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PLoS One. 2013 Jul 24;8(7):e68713. doi: 10.1371/journal.pone.0068713. Print 2013.

Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study.

Author information

  • 1Department of Internal Medicine, Limoges University Hospital, Limoges, France. yvanjamilloux@hotmail.com

Abstract

OBJECTIVES:

Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency.

SUBJECTS AND DESIGN:

150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared.

RESULTS:

At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05).

CONCLUSION:

Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians' vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.

PMID:
23894335
PMCID:
PMC3722149
DOI:
10.1371/journal.pone.0068713
[PubMed - indexed for MEDLINE]
Free PMC Article
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