title: Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study.
abstract: OBJECTIVE
  Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency.
  
  
  METHODS
  150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared.
  
  
  RESULTS
  At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05).
  
  
  CONCLUSIONS
  Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians' vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.
authors.affiliation: Department of Internal Medicine, Limoges University Hospital, Limoges, France. yvanjamilloux@hotmail.com
authors.forename: Yvan
authors.initials: Y
authors.lastname: Jamilloux
authors.forename: Eric
authors.initials: E
authors.lastname: Liozon
authors.forename: Gregory
authors.initials: G
authors.lastname: Pugnet
authors.forename: Sylvie
authors.initials: S
authors.lastname: Nadalon
authors.forename: Kim
authors.initials: K
authors.lastname: Heang Ly
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dumonteil
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gondran
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Fauchais
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Vidal
mesh_terms: D000309:Adrenal Insufficiency / Q000188:drug therapy; D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D013700:Giant Cell Arteritis / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male
chemical_list: D005938:Glucocorticoids; D000324:Adrenocorticotropic Hormone
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