A Retrospective Study on Weaning Glucocorticoids and Recovery of the Hypothalamic–Pituitary–Adrenal Axis Article Swipe
Muhammad Fahad Arshad
,
Charlotte Elder
,
John Newell‐Price
,
Richard Ross
,
Miguel Debono
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1210/clinem/dgae059
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1210/clinem/dgae059
Context Glucocorticoids suppress the hypothalamic–pituitary–adrenal (HPA) axis, resulting in tertiary adrenal insufficiency (AI). When weaning patients off glucocorticoids there is no consensus on whether to maintain patients on prednisolone or convert to hydrocortisone. Objective To investigate HPA axis recovery in patients on long-term prednisolone and assess outcome after hydrocortisone conversion. Methods This was a retrospective cohort study at an outpatient endocrine steroid clinic. Patients were on long-term prednisolone and referred for HPA axis testing between 2015 and 2022. The main outcomes measured were (1) HPA axis recovery rate in patients on prednisolone demonstrated by a normal adrenocorticotrophic hormone (ACTH) stimulation test (AST) and (2) HPA axis recovery rate subanalysis of dose-matched patients with confirmed tertiary AI on prednisolone or hydrocortisone were measured. Results In total, 206 patients on prednisolone were tested for tertiary AI. Of these, 176 remained on prednisolone while 30 were converted to hydrocortisone. The overall HPA axis recovery rate for patients on prednisolone after interval testing was 137/206 (66.5%). The HPA axis recovery rate in dose-matched prednisolone and hydrocortisone conversion groups was 7/10 (70%) and 2/13 (15%) (P = .008), respectively. There was no difference in mean (SD) age (67.1 [12.2] vs 63.4 [11.1] years; P = .464) and baseline cortisol (5.3 [4.2] vs 4.6 [3.1] µg/dL; P = .648) and median [interquartile, IQR] glucocorticoid duration (1213 [1114] vs 2316 [4808] days; P = .693) and baseline ACTH (20.5 [29.0] vs 16.3 [14.8] ng/L; P = .905) between dose-matched prednisolone and hydrocortisone groups. Follow-up duration in the prednisolone group was significantly lower (median [IQR] 348 [975] vs 667 [884] days; P = .012). Conclusion Patients with glucocorticoid-induced AI maintained on once-daily prednisolone can recover HPA axis function when weaning. There is no apparent advantage to recover HPA axis function in converting to multiple-dosing hydrocortisone.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1210/clinem/dgae059
- https://academic.oup.com/jcem/advance-article-pdf/doi/10.1210/clinem/dgae059/56524466/dgae059.pdf
- OA Status
- hybrid
- Cited By
- 9
- References
- 40
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4391447007
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4391447007Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1210/clinem/dgae059Digital Object Identifier
- Title
-
A Retrospective Study on Weaning Glucocorticoids and Recovery of the Hypothalamic–Pituitary–Adrenal AxisWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-01-31Full publication date if available
- Authors
-
Muhammad Fahad Arshad, Charlotte Elder, John Newell‐Price, Richard Ross, Miguel DebonoList of authors in order
- Landing page
-
https://doi.org/10.1210/clinem/dgae059Publisher landing page
- PDF URL
-
https://academic.oup.com/jcem/advance-article-pdf/doi/10.1210/clinem/dgae059/56524466/dgae059.pdfDirect link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
hybridOpen access status per OpenAlex
- OA URL
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https://academic.oup.com/jcem/advance-article-pdf/doi/10.1210/clinem/dgae059/56524466/dgae059.pdfDirect OA link when available
- Concepts
-
Prednisolone, Hydrocortisone, Medicine, Internal medicine, Adrenal insufficiency, Endocrinology, Retrospective cohort study, Adrenocorticotropic hormone, Interquartile range, Glucocorticoid, HormoneTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
9Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 6, 2024: 3Per-year citation counts (last 5 years)
- References (count)
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40Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.function | 280, 292 |
| abstract_inverted_index.interval | 158 |
| abstract_inverted_index.maintain | 26 |
| abstract_inverted_index.measured | 82 |
| abstract_inverted_index.outcomes | 81 |
| abstract_inverted_index.patients | 16, 27, 41, 90, 112, 127, 154 |
| abstract_inverted_index.recovery | 39, 87, 107, 151, 166 |
| abstract_inverted_index.referred | 70 |
| abstract_inverted_index.remained | 138 |
| abstract_inverted_index.suppress | 3 |
| abstract_inverted_index.tertiary | 10, 115, 133 |
| abstract_inverted_index.weaning. | 282 |
| abstract_inverted_index.Follow-up | 247 |
| abstract_inverted_index.Objective | 34 |
| abstract_inverted_index.advantage | 287 |
| abstract_inverted_index.confirmed | 114 |
| abstract_inverted_index.consensus | 22 |
| abstract_inverted_index.converted | 144 |
| abstract_inverted_index.endocrine | 61 |
| abstract_inverted_index.long-term | 43, 67 |
| abstract_inverted_index.measured. | 122 |
| abstract_inverted_index.resulting | 8 |
| abstract_inverted_index.Conclusion | 267 |
| abstract_inverted_index.conversion | 173 |
| abstract_inverted_index.converting | 294 |
| abstract_inverted_index.difference | 188 |
| abstract_inverted_index.maintained | 272 |
| abstract_inverted_index.once-daily | 274 |
| abstract_inverted_index.outpatient | 60 |
| abstract_inverted_index.conversion. | 50 |
| abstract_inverted_index.investigate | 36 |
| abstract_inverted_index.stimulation | 100 |
| abstract_inverted_index.subanalysis | 109 |
| abstract_inverted_index.demonstrated | 93 |
| abstract_inverted_index.dose-matched | 111, 169, 242 |
| abstract_inverted_index.prednisolone | 29, 44, 68, 92, 118, 129, 140, 156, 170, 243, 251, 275 |
| abstract_inverted_index.insufficiency | 12 |
| abstract_inverted_index.respectively. | 184 |
| abstract_inverted_index.retrospective | 55 |
| abstract_inverted_index.significantly | 254 |
| abstract_inverted_index.glucocorticoid | 218 |
| abstract_inverted_index.hydrocortisone | 49, 120, 172, 245 |
| abstract_inverted_index.Glucocorticoids | 2 |
| abstract_inverted_index.[interquartile, | 216 |
| abstract_inverted_index.glucocorticoids | 18 |
| abstract_inverted_index.hydrocortisone. | 33, 146, 297 |
| abstract_inverted_index.multiple-dosing | 296 |
| abstract_inverted_index.adrenocorticotrophic | 97 |
| abstract_inverted_index.glucocorticoid-induced | 270 |
| abstract_inverted_index.hypothalamic–pituitary–adrenal | 5 |
| cited_by_percentile_year.max | 99 |
| cited_by_percentile_year.min | 96 |
| corresponding_author_ids | https://openalex.org/A5078051105 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 5 |
| corresponding_institution_ids | https://openalex.org/I4210102902, https://openalex.org/I91136226 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.6100000143051147 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.94574109 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |