[Endocrine consequences of corticotherapy. Weaning from long-term corticotherapy]

Long term corticosteroid therapy has multiple effects on the endocrine system. These include adrenocortical suppression in high doses, alteration of gonadotropic and gonadal secretion, slowing down of long bone growth and bone maturation in children, osteoporosis in adults, alteration of the thyrotropic function and changes in thyroxine peripheral metabolism, diabetogenic effect. The list is not exhaustive, and there are more complex effects on the secretion of prolactin, pancreatic peptides, VIP, etc. Because of these various effects, the pros and cons of long term corticosteroid therapy must be carefully weighted, and if it is necessary steroids should be prescribed in such a way as to limit their side-effects: at best one dose taken in the morning every other day, together with the prescription of calcium, of a salt-free diet and, in some cases, of androgens or oestrogens. Weaning must be carried out with caution, to avoid rebound of the disease treated, and with substitution of hydrocortisone when the corticosteroid dosage reaches 5 mg per day of prednisone or equivalent and can be interrupted. The functional soundness or alteration of the corticotropic and adrenal functions must then be evaluated by testing corticotropic and adrenal functions must then be evaluated by testing the adrenocortical response to tetracosactrin, or even better by measuring early morning concentrations of blood cortisol. Depending on the results obtained, hydrocortisone can be withdrawn and limited to episodes of stress, or continued until ACTH and endogenous cortisol levels have returned to normal values.