title: Recovery of adrenal function after chronic secondary adrenal insufficiency in patients with hypopituitarism.
abstract: Previous studies have reported recovery of secondary adrenal insufficiency (SAI) in patients with pituitary disorders, generally immediately after pituitary surgery; however, data regarding recovery of long-term SAI are lacking. We conducted a study to assess the longer term recovery rate of SAI in patients with pituitary disorders.
  
  
  
  We identified all SAI patients in the Halifax Neuropituitary Database from 1 November 2005 to 30 September 2014, who had required glucocorticoid therapy for ≥3 months, and had a minimum follow-up of 6 months. Patients with ACTH-secreting adenomas, those receiving glucocorticoids only in the routine peri-operative period for pituitary surgery and those on glucocorticoids for nonpituitary conditions were excluded. SAI was defined as either basal serum cortisol < 130 nm and/or a subnormal cortisol response to ACTH-(1-24) stimulation test or insulin tolerance test response.
  
  
  
  Fifty-one patients fulfilled the criteria. Nine (17·6%) patients had complete recovery of SAI over a median of 20 months (range: 8-51) after initiating glucocorticoid replacement. Patients with smaller tumour size had increased likelihood of hypothalamic-pituitary-adrenal (HPA) axis recovery, whereas those with secondary hypogonadism or growth hormone deficiency were less likely to recover. Those with initial cortisol >175 nm had an almost one in two chance of recovery.
  
  
  
  Results from our study show that approximately one in six patients with SAI recover adrenal function, even up to 5 years after diagnosis. We recommend that patients with SAI undergo regular testing to assess recovery in order to prevent unnecessary glucocorticoid therapy.
authors.affiliation: Division of Endocrinology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Munro
authors.affiliation: Division of Endocrinology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Tugwell
authors.affiliation: Research Methods Unit, Department of Community Health and Epidemiology, Nova Scotia Health Authority, Halifax, NS, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Doucette
authors.affiliation: Division of Endocrinology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.|Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: D B
authors.initials: DB
authors.lastname: Clarke
authors.affiliation: Division of Endocrinology, Department of Medicine and Research Center, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Lacroix
authors.affiliation: Division of Endocrinology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: S A
authors.initials: SA
authors.lastname: Imran
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007018:Hypopituitarism / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D006854:Hydrocortisone