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首页> 外文期刊>BMC Nephrology >Glucocorticoid induced adrenal insufficiency is common in steroid treated glomerular diseases - proposed strategy for screening and management
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Glucocorticoid induced adrenal insufficiency is common in steroid treated glomerular diseases - proposed strategy for screening and management

机译：糖皮质激素引起的肾上腺功能不全在类固醇治疗的肾小球疾病中很常见-建议的筛查和治疗策略

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Glucocorticoids (GCs) are frequently used to treat glomerular diseases but are associated with multiple adverse effects including hypothalamic-pituitary-adrenal axis inhibition that can lead to adrenal insufficiency (AI) on withdrawal. There is no agreed GC tapering strategy to minimise this risk. This is a single centre retrospective study, between 2013 to 2016, of patients with glomerular disease on GC therapy for more than 3?months screened for GC induced AI with short synacthen stimulation tests (SSTs) done prior to complete GC withdrawal. We investigated the prevalence of AI, predictors, choice of screening tool and recovery. Biochemical evidence of GC induced AI was found in 57 (46.3%) patients. Total duration of GC did not differ between those with and without AI (p?=?0.711). Patients with GC induced AI had a significantly lower pre-synacthen baseline cortisol as compared to patients without AI. A cut off pre-synacthen baseline cortisol of ≥223.5?nmol/l had a specificity of 100% for identifying individuals without biochemical AI. Patients with GC induced AI took a mean of 8.7?±?4.6?months (mean?±?SD) to recover. Patients with persistent AI had a significantly lower index post-synacthen cortisol measurement. We demonstrate that biochemically proven GC induced AI is common in patients with glomerular diseases, is not predicted by daily dose or duration and takes a considerable time to recover. The study supports the use of morning basal cortisol testing as an appropriate means to avoid the need for SSTs in all patients and should be performed in all patients prior to consideration of GC withdrawal after 3?months duration.
机译：糖皮质激素（GCs）通常用于治疗肾小球疾病，但与多种不良反应相关，包括下丘脑-垂体-肾上腺轴抑制，可能导致戒断时肾上腺功能不全（AI）。没有商定的GC缩减策略来最大程度地降低这种风险。这是一项单中心回顾性研究，在2013年至2016年之间，对接受GC治疗的肾小球疾病患者进行了3个月以上的筛查，以筛查GC诱导的AI，并在完全撤离GC前进行了短暂的合成突触刺激试验（SST）。我们调查了AI的患病率，预测因素，筛选工具的选择和恢复。有GC（57.6％）的患者发现了GC诱导的AI的生化证据。有和没有AI者的GC总持续时间没有差异（p？=？0.711）。与没有AI的患者相比，患有GC诱导的AI的患者的合成前促肾上腺皮质激素水平要低得多。合成前的基线合成皮质醇≥223.5？nmol / l的截断特异性为100％，可用于鉴定没有生化AI的个体。 GC诱导的AI患者平均需要8.7？±？4.6？个月（平均±±SD）的时间才能恢复。持续性AI患者的Synynhen皮质醇测量指标明显较低。我们证明，经生化证明，GC诱导的AI在肾小球疾病患者中很常见，无法通过每日剂量或持续时间预测，并且需要相当长的时间才能恢复。该研究支持使用晨间基础皮质醇检测作为避免所有患者均需要SST的一种适当手段，并且应在所有患者中进行3个月的研究，然后再考虑停用GC。

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