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Adrenocortical responsiveness after discontinuous corticosteroid therapy
Klinische Wochenschrift
|January 15, 1986
Summary
The three-out-of-four-day steroid regimen preserves adrenal function better than daily steroid treatment. This regimen offers advantages for patients needing steroids but experiencing adrenal insufficiency with daily dosing.
Area of Science:
- Endocrinology
- Pharmacology
Background:
- Glucocorticoid therapy is essential for managing various conditions.
- Continuous steroid use can suppress the hypothalamic-pituitary-adrenal (HPA) axis.
- Alternate-day or intermittent dosing strategies aim to mitigate HPA axis suppression.
Purpose of the Study:
- To compare the impact of a three-out-of-four-day steroid regimen versus daily steroid treatment on adrenal function.
- To evaluate adrenal responsiveness to adrenocorticotropic hormone (ACTH) in patients on different glucocorticoid schedules.
Main Methods:
- Measured plasma cortisol levels and adrenal response to 0.25 mg ACTH.
- Studied three groups: patients on a three-out-of-four-day regimen (n=12), patients on daily prednisone (n=10), and normal subjects (n=9).
- Patients received ≥15 mg prednisone or equivalent daily.
Main Results:
- Basal plasma cortisol in the three-out-of-four-day group was intermediate between daily steroid users and normal subjects.
- Adrenal function was slightly diminished but adequate for stress response in the three-out-of-four-day group.
- Adrenal function was insufficient in all patients on daily steroids.
Conclusions:
- The three-out-of-four-day steroid regimen preserves adrenal function more effectively than daily dosing.
- This intermittent regimen is a viable alternative for patients requiring glucocorticoids, especially those experiencing adrenal insufficiency with continuous therapy.
- Offers a potentially advantageous treatment strategy over continuous steroid administration.