Recovery of the hypothalamic-pituitary-adrenal axis from suppression by short-term, high-dose intravenous prednisolone therapy in patients with MS.
We have studied the recovery of the hypothalamic-pituitary-adrenal (HPA) axis from inhibition by short-term, intravenous high-dose, corticosteroid therapy (IVHDCT) without subsequent oral replacement therapy in 10 patients with relapsing-remitting or progressive multiple sclerosis (MS) using the human corticotrophin-releasing hormone (hCRH) test. There was significant HPA suppression with profoundly decreased basal and peak plasma ACTH and cortisol levels 24 h after cessation of therapy. However, at 48 h the pituitary response was greatly enhanced with peak ACTH concentrations rising by more than 100% over baseline values in 7 of 10 patients. Basal and stimulated ACTH concentrations returned to pre-treatment levels at 120 h. Basal and stimulated plasma cortisol levels remained subnormal in 6 patients 120 h after IVHDCT. We conclude that IVHDCT without oral replacement therapy in MS patients is endocrinologically safe.
Wenning
G K
GK
Department of Neurology, University of Tübingen, Germany.
Wiethölter
H
H
Schnauder
G
G
Müller
P H
PH
Kanduth
S
S
Renn
W
W
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects* / Q000502:physiology; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000097:blood / Q000188:drug therapy*; D010913:Pituitary-Adrenal System / Q000187:drug effects* / Q000502:physiology; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*
D000324:Adrenocorticotropic Hormone; D011239:Prednisolone; D006854:Hydrocortisone