title: Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency.
abstract: BACKGROUND
  The chronic use of glucocorticoids (GC) suppresses function of the hypothalamic-pituitary-adrenal axis and often results in secondary adrenal insufficiency (AI). The present study aimed to determine the recovery rate of adrenal function in patients with secondary AI within 1 to 2 years and to assess the factors predictive of adrenal function recovery.
  
  
  METHODS
  This was a retrospective observational study that enrolled patients diagnosed with GC-induced secondary AI between 2007 and 2013. AI was defined by peak serum cortisol levels <18 μg/dL during a standard-dose short synacthen test (SST). A follow-up SST was performed after 1 to 2 years, and responders were defined as those with adrenocorticotropic hormone (ACTH)-stimulated peak serum cortisol levels ≥18 μg/dL.
  
  
  RESULTS
  Of the total 34 patients diagnosed with GC-induced secondary AI at first, 20 patients (58.8%) recovered normal adrenal function by the time of the follow-up SST (median follow-up period, 16.5 months). Although the baseline serum ACTH and cortisol levels at the first SST did not differ between responders and non-responders, the incremental cortisol response during the first SST was higher in responders than that of non-responders (7.88 vs. 3.56, P<0.01). Additionally, higher cortisol increments during the first SST were an independent predictive factor of the adrenal function recovery (odds ratio, 1.58; 95% confidence interval, 1.02 to 2.46; P<0.05).
  
  
  CONCLUSIONS
  In the present study, adrenal function recovery was achieved frequently in patients with GC-induced secondary AI within 1 to 2 years. Additionally, an incremental cortisol response at the first SST may be an important predictive factor of adrenal function recovery.
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Jong Ha
authors.initials: JH
authors.lastname: Baek
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Soo Kyoung
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.|Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.|Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
authors.forename: Jong Ryeal
authors.initials: JR
authors.lastname: Hahm
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.|Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea. taesikjung@gmail.com.
authors.forename: Jaehoon
authors.initials: J
authors.lastname: Jung
keywords: Adrenal insufficiency; Glucocorticoids; Predictive factor; Recovery