Adrenal Dysfunction after Steroids in PMR and GCA Patients Save

GC are widespreadly and chronically used in rheumatology, often with the concern of adrenal insufficiency with GC cessation. A cross-Danish study of polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA) patients participating in a randomized clinical trial and were studied a median 39 (IQR 25-62) days after planned cessation of prednisolone.  

These patients had been GC exposed with prednisolone for a median of 13 (10-20) months prior to cessation.  The primary outcome was the frequency of GC-induced adrenal insufficiency (GIAI) after planned cessation. GIAI was defined as a stimulated plasma cortisol test (SST) level less than 420 nmol/L in response to a short 250 μg corticotropin test (SST). 

A total of 267 patients were included (55% female, median age 73 years).  While only 5 patients (1.9%) developed GIAI by SST, another 75 patients (34%) had adrenal insufficiency symptoms. Those with symptoms had lower basal cortisol levels compared with the asymptomatic group (263 nmol/L vs 309 nmol/L; P < .001). 

Risk factors for adrenal insufficiency symptoms included female sex (PR 1.68), increased body fat percentage (PR 2.33), reduced handgrip strength (PR 2.71) and low Short Physical Performance Battery score (PR, 2.78).

Finding only 2% with GC-induced adrenal insufficiency was much lower than previously reported.  These findings suggest that routine screening for adrenal insufficiency should be discouraged and possibly, only restricted to patients with overt symptoms. Nevertheless, this cohort had a high prevalence of adrenal insufficiency symptoms with cessations, substantiating the clinical challenges of steroid withdrawal.