A Retrospective Study on Weaning Glucocorticoids and Recovery of the Hypothalamic–Pituitary–Adrenal Axis
Authors' 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.
Study context
- Population
- Patients on long-term prednisolone referred for hypothalamic-pituitary-adrenal (HPA) axis testing, 2015–2022
- Participants
- 206 patients
- Exposure
- Remaining on prednisolone vs conversion to hydrocortisone
- Prednisolonen = 176reference
- Hydrocortisonen = 30
- Outcome
- (1) HPA axis recovery rate on prednisolone (normal ACTH stimulation test); (2) HPA axis recovery rate in dose-matched patients with confirmed tertiary adrenal insufficiency (AI) on prednisolone or hydrocortisone
Methodological detailssingle outpatient endocrine steroid clinic
- Single outpatient endocrine steroid clinic
Main finding
As reported in the abstract
HPA axis recovery rate
P = 0.008
Observational data: associations, not effects.
Further findings
Follow-up duration · significantly lower with prednisolone
P = 0.012
- Baseline characteristics, dose-matched groups · age, mean (SD) 67.1 [12.2] vs 63.4 [11.1] years
- P = 0.464
- Baseline characteristics, dose-matched groups · baseline cortisol 5.3 [4.2] vs 4.6 [3.1] µg/dL
- P = 0.648
- Baseline characteristics, dose-matched groups
- P = 0.693
- Baseline characteristics, dose-matched groups · baseline adrenocorticotrophic hormone (ACTH) 20.5 [29.0] vs 16.3 [14.8] ng/L
- P = 0.905
- Baseline characteristics, dose-matched groups: glucocorticoid duration, median [IQR] 1213 [1114] vs 2316 [4808] days
Baseline characteristics, dose-matched groups
- No difference in age, baseline cortisol, glucocorticoid duration or baseline ACTH between dose-matched groups
Original publication
A Retrospective Study on Weaning Glucocorticoids and Recovery of the Hypothalamic–Pituitary–Adrenal Axis. J Clin Endocrinol Metab. Published 31 January 2024. doi:10.
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