[Do we still have glucocorticoid-induced adrenal insufficiency?].
Adrenal insufficiency (AI) induced by glucocorticoids was first described more than 50 years ago in patients undergoing surgical stress. Although considered the most frequent cause of AI, the true incidence of this complication of glucocorticoid treatment remains unknown. No factors are known to predict AI after glucocorticoid treatment. In particular, neither the dose nor the duration of treatment seems predictive. The minimum dose of cortisol necessary for the body to cope with medical or surgical stress is unknown. The adrenocorticotropin test is often used during corticosteroid withdrawal because it is well correlated with adrenal response to surgical stress, but not with clinical events. Studies over the past 15 years have shown that the perioperative risk of AI has been overestimated and that hydrocortisone doses should be decreased. A prospective study of patients after steroid withdrawal is the only means of assessing the true incidence of this complication to propose a rational strategy to prevent it.
Goichot
Bernard
B
Service de médecine interne et nutrition, Hôpital de Hautepierre, Hôpitaux universitaires, Strasbourg. bernard.goichot@chru-strasbourg.fr
Vinzio
Stéphane
S
Luca
Florina
F
Schlienger
Jean-Louis
JL
D000309:Adrenal Insufficiency / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D000324:Adrenocorticotropic Hormone; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015984:Causality; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006728:Hormones; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D015994:Incidence; D019990:Perioperative Care; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology; D011159:Population Surveillance; D011237:Predictive Value of Tests; D015995:Prevalence; D013312:Stress, Physiological / Q000188:drug therapy / Q000209:etiology
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D006728:Hormones; D000324:Adrenocorticotropic Hormone