Related Experiment Video
Updated: May 10, 2026
08:02
Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
Published on: April 25, 2016
Pituitary-adrenal function after prolonged glucocorticoid therapy for systemic inflammatory disorders: an
K Sacre1, M Dehoux, M P Chauveheid
1Department of Internal Medicine, Paris Diderot University, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, F-75018, Paris, France.
The Journal of Clinical Endocrinology and Metabolism
|June 14, 2013
Summary
Long-term glucocorticoid therapy frequently causes adrenal insufficiency in patients with systemic inflammatory disorders. Both the duration and cumulative dose of prednisone predict this risk.
Area of Science:
- Endocrinology
- Internal Medicine
- Pharmacology
Background:
- Glucocorticoid therapy is widely used for systemic disorders.
- Older studies suggested no link between glucocorticoid dose/duration and adrenal insufficiency risk.
Purpose of the Study:
- To evaluate long-term glucocorticoid therapy's impact on the pituitary-adrenal axis in patients with systemic inflammatory disorders.
Main Methods:
- Retrospective observational study (Jan 2011-Aug 2012) at Bichat Hospital, Paris.
- Included 60 patients on long-term prednisone for systemic inflammatory disorders.
- Assessed pituitary-adrenal dysfunction using a short Synacthen test (0.25 mg 1-24-ACTH) and cortisol measurements.
Main Results:
- 48.3% of patients exhibited adrenal insufficiency (cortisol <100 nmol/L at baseline or <550 nmol/L at 60 min).
- Cumulative prednisone dose and exposure duration predicted adrenal insufficiency.
- Most patients (93.5%) with normal Synacthen test results discontinued prednisone without requiring hydrocortisone replacement.
Conclusions:
- Adrenal insufficiency is common in patients receiving long-term glucocorticoids for systemic inflammatory disorders.
- The risk of adrenal insufficiency is associated with the duration and cumulative dose of steroid therapy.
Related Concept Videos
01:19Cushing Syndrome II: Pathophysiology
Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...
01:26Cushing Syndrome I: Introduction
Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...
01:37Hypothalamic-Pituitary Axis
The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.
01:27Adrenal Gland Disorders
Adrenal gland disorders manifest when the production of adrenal hormones deviates from the norm, resulting in either excessive or insufficient concentrations.
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...