Adrenal axis integrity after IV methylprednisolone therapy for thyroid eye disease: a retrospective cohort study
Authors' conclusion
In this cohort, adrenal responsiveness to the 250 μg ACTH test 7-10 days after completion of IVMP was preserved in all patients, suggesting that early post-treatment secondary adrenal insufficiency is uncommon. Although reassuring, these results should be interpreted cautiously, and clinicians should continue to rely on clinical judgment, supported by biochemical testing when indicated.
Study context
- Population
- Adults with active moderate-to-severe thyroid eye disease (TED) treated with intravenous methylprednisolone (IVMP), Department of Endocrinology and Metabolic Diseases, University General Hospital of Larissa, Greece115 tested
- Participants
- 127 adults
- Outcome
- Hypothalamic-pituitary-adrenal (HPA) axis integrity on 250-μg ACTH(1-24) stimulation test; peak cortisol ≥18.1 μg/dL (≥500 nmol/L) indicative of adrenal sufficiency
- Follow-up
- 7-10 days after final IVMP dose
Methodological detailsobservational, single-centre, 12 patients excluded due to unavailability of testing or contraindications
- Observational
- Single-centre
- 12 patients excluded due to unavailability of testing or contraindications
Main finding
As reported in the abstract
Adequate cortisol response at 30 min
93%
Met sufficiency threshold at 60 min
100%
Observational data: associations, not effects.
Further findings
Baseline cortisol ≥18.1 μg/dL among patients tested · 7-10 days after final IVMP dose
- Baseline cortisol ≥18.1 μg/dL
- 15 (13%)
- 115 patients tested
Adequate cortisol response at 30 min post-ACTH
- Adequate cortisol response at 30 min
- 93%
Patients with baseline cortisol <5 μg/dL (150 nmol/L)
- All patients with baseline cortisol <5 μg/dL demonstrated intact adrenal function on dynamic testing
Original publication
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