Glucocorticoid-induced adrenal insufficiency after therapy with intravenous methylprednisolone in patients with moderate-to-severe and active Graves’ orbitopathy: assessment with a low-dose corticotropin test
Journal of Endocrinological Investigation - Trang 1-8 - 2024
Tóm tắt
We aimed to assess adrenal function following treatment of moderate-to-severe and active Graves’ orbitopathy (GO) with intravenous methylprednisolone (IVMP) in weekly pulses in a cumulative dose of 4.5 or 7.5 g. We evaluated the impact of IVMP pulses on adrenal reserve using a low-dose (1 μg) ACTH stimulation test (LDT) for the first time. In this prospective study we evaluated adrenal function in 21 patients with moderate-to-severe and active GO treated with 12 weekly IVMP pulses according to the European Group on Graves’ Orbitopathy (EUGOGO) recommendations. We assessed serum cortisol, plasma adrenocorticotropic hormone (ACTH), and dehydroepiandrosterone sulfate (DHEA-S) levels before the 1st and 12th IVMP pulse. We performed dynamic testing using LDT before the 12th IVMP pulse in all patients. In those who failed LDT, adrenal function was reassessed with LDT and the overnight metyrapone test after 4–7 weeks. Two patients failed to achieve serum cortisol levels ≥ 18.1 μg/dL at 30 and 60 min in LDT and were diagnosed with glucocorticoid-induced adrenal insufficiency (GC-induced AI). They were recommended to take hydrocortisone in situations of acute stress. Both patients were reassessed within 4–7 weeks after treatment cessation and showed an adequate response in LDT and overnight metyrapone test. We observed a statistically significant decrease in DHEA-S levels (p = 0.004) before the 12th IVMP pulse compared to baseline in all patients. For the first time, our research shows that administering IVMP in 12 weekly pulses can result in GC-induced AI. We suggest that patients should undergo careful evaluation for GC-induced AI, including LDT, after therapy with IVMP according to EUGOGO guidelines. Screening for altered adrenal reserve could prevent life-threatening complications, particularly during acute stress situations.
Tài liệu tham khảo
Raschi E, Fusaroli M, Massari F et al (2022) The changing face of drug-induced adrenal insufficiency in the food and drug administration adverse event reporting system. J Clin Endocrinol Metab 107:e3107–e3114. https://doi.org/10.1210/clinem/dgac359
Charmandari E, Nicolaides NC, Chrousos GP (2014) Adrenal insufficiency. Lancet 383:2152–2167. https://doi.org/10.1016/S0140-6736(13)61684-0
Broersen LHA, Pereira AM, Jørgensen JOL, Dekkers OM (2015) Adrenal insufficiency in corticosteroids use : systematic review and meta-analysis. J Clin Endocrinol Metab 100:2171–2180. https://doi.org/10.1210/jc.2015-1218
Graber AL, Ney RL, Nicholson WE et al (1965) Natural history of pituitary-adrenal recovery following long-term suppression with corticosteroids. J Clin Endocrinol Metab 25:11–16. https://doi.org/10.1210/jcem-25-1-11
Hahner S, Spinnler C, Fassnacht M et al (2015) High incidence of adrenal crisis in educated patients with chronic adrenal insufficiency: a prospective study. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2014-3191
Joseph RM, Hunter AL, Ray DW, Dixon WG (2016) Systemic glucocorticoid therapy and adrenal insufficiency in adults: a systematic review. Semin Arthritis Rheum 46:133–141. https://doi.org/10.1016/j.semarthrit.2016.03.001
Woods CP, Argese N, Chapman M et al (2015) Adrenal suppression in patients taking inhaled glucocorticoids is highly prevalent and management can be guided by morning cortisol. Eur J Endocrinol. https://doi.org/10.1530/EJE-15-0608
Lipworth BJ (1999) Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis. Arch Intern Med 159:941–955
Gazis AG, Homer JJ, Henson DB et al (1999) The effect of six weeks topical nasal betamethasone drops on the hypothalamo-pituitary-adrenal axis and bone turnover in patients with nasal polyposis. Clin Otolaryngol Allied Sci 24:495–498
Habib G, Jabbour A, Artul S, Hakim G (2014) Intra-articular methylprednisolone acetate injection at the knee joint and the hypothalamic–pituitary–adrenal axis: a randomized controlled study. Clin Rheumatol 33:99–103. https://doi.org/10.1007/s10067-013-2374-4
Paragliola RM, Papi G, Pontecorvi A, Corsello SM (2017) Treatment with synthetic glucocorticoids and the hypothalamus-pituitary-adrenal axis. Int J Mol Sci. https://doi.org/10.3390/ijms18102201
Prete A, Bancos I (2021) Glucocorticoid induced adrenal insufficiency. BMJ 374:n1380. https://doi.org/10.1136/bmj.n1936
Bartalena L, Kahaly GJ, Baldeschi L et al (2021) The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy. Eur J Endocrinol 185:G43–G67. https://doi.org/10.1530/EJE-21-0479
Ambroziak U, Bluszcz G, Bednarczuk T, Miśkiewicz P (2017) The influence of Graves’ orbitopathy treatment with intravenous glucocorticoids on adrenal function. Endokrynol Pol 68:430–433. https://doi.org/10.5603/EP.a2017.0036
Giotaki Z, Fountas A, Tsirouki T et al (2015) Adrenal reserve following treatment of graves’ orbitopathy with intravenous glucocorticoids. Thyroid 25:462–463. https://doi.org/10.1089/thy.2014.0533
Jespersen S, Nygaard B, Kristensen LØ (2015) Methylprednisolone pulse treatment of graves’ ophthalmopathy is not associated with secondary adrenocortical insufficiency. Eur Thyroid J 4:222–225. https://doi.org/10.1159/000440834
Pelewicz K, Szewczyk S, Miśkiewicz P (2020) Treatment with intravenous methylprednisolone in patients with graves’ orbitopathy significantly affects adrenal function: assessment of serum, salivary cortisol and serum dehydroepiandrosterone sulfate. J Clin Med. https://doi.org/10.3390/jcm9103233
Broide J, Soferman R, Kivity S et al (1995) Low-dose adrenocorticotropin test reveals impaired adrenal function in patients taking inhaled corticosteroids. J Clin Endocrinol Metab 80:1243–1246. https://doi.org/10.1210/jcem.80.4.7714095
Tordjman K, Jaffe A, Grazas N et al (1995) The role of the low dose (1 μg) adrenocorticotropin test in the evaluation of patients with pituitary diseases. J Clin Endocrinol Metab. https://doi.org/10.1210/jcem.80.4.7714104
Fleseriu M, Hashim IA, Karavitaki N et al (2016) Hormonal replacement in hypopituitarism in adults: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 101:3888–3921. https://doi.org/10.1210/jc.2016-2118
de Miguel Novoa P, Vela ET, García NP et al (2014) Guidelines for diagnosis and treatment of adrenal insufficiency in adults. Endocrinol y Nutr (English ed) 61:1–34. https://doi.org/10.1016/S2173-5093(14)70069-8
Burgos N, Ghayee HK, Singh-Ospina N (2019) Pitfalls in the interpretation of the cosyntropin stimulation test for the diagnosis of adrenal insufficiency. Curr Opin Endocrinol Diabetes Obes 26:139–145. https://doi.org/10.1097/MED.0000000000000473
Ospina NS, Al Nofal A, Bancos I et al (2016) ACTH stimulation tests for the diagnosis of adrenal insufficiency: systematic review and meta-analysis. J Clin Endocrinol Metab 101:427–434. https://doi.org/10.1210/jc.2015-1700
Mayenknecht J, Diederich S, Bähr V et al (1998) Comparison of low and high dose corticotropin stimulation tests in patients with pituitary disease. J Clin Endocrinol Metab 83:1558–1562. https://doi.org/10.1210/jcem.83.5.4831
Dorin RI, Qualls CR, Crapo LM (2003) Diagnosis of adrenal insufficiency. Ann Intern Med 139:194. https://doi.org/10.7326/0003-4819-139-3-200308050-00009
Kazlauskaite R, Evans AT, Villabona CV et al (2008) Corticotropin tests for hypothalamic-pituitary-adrenal insufficiency: a metaanalysis. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2008-0710
Fragoso Perozo AFD, Fontes R, Lopes FP et al (2023) Morning serum cortisol role in the adrenal insufficiency diagnosis with modern cortisol assays. J Endocrinol Invest. https://doi.org/10.1007/s40618-023-02062-y
Willenberg HS (2009) Adrenal insufficiency, secondary BT-encyclopedia of molecular mechanisms of disease. In: Lang F (ed). Springer, Berlin, Heidelberg, pp. 44–45
Kalaria T, Buch H, Agarwal M et al (2022) Morning serum cortisol is superior to salivary cortisone and cortisol in predicting normal adrenal function in suspected adrenal insufficiency. Clin Endocrinol (Oxf) 96:916–918. https://doi.org/10.1111/cen.14388
Bancos I, Hahner S, Tomlinson J, Arlt W (2015) Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol 3:216–226. https://doi.org/10.1016/S2213-8587(14)70142-1
Nasrallah MP, Arafah BM (2003) The value of dehydroepiandrosterone sulfate measurements in the assessment of adrenal function. J Clin Endocrinol Metab 88:5293–5298. https://doi.org/10.1210/jc.2003-030449
Sayyed Kassem L, El Sibai K, Chaiban J et al (2012) Measurements of serum DHEA and DHEA sulphate levels improve the accuracy of the low-dose cosyntropin test in the diagnosis of central adrenal insufficiency. J Clin Endocrinol Metab 97:3655–3662. https://doi.org/10.1210/jc.2012-1806
Al-Aridi R, Abdelmannan D, Arafah BM (2011) Biochemical diagnosis of adrenal insufficiency: the added value of dehydroepiandrosterone sulfate measurements. Endocr Pract 17:261–270. https://doi.org/10.4158/EP10262.RA
Raverot V, Richet C, Morel Y et al (2016) Establishment of revised diagnostic cut-offs for adrenal laboratory investigation using the new Roche Diagnostics Elecsys® Cortisol II assay. Ann Endocrinol (Paris) 77:620–622. https://doi.org/10.1016/j.ando.2016.05.002
Kline GA, Buse J, Krause RD (2017) Clinical implications for biochemical diagnostic thresholds of adrenal sufficiency using a highly specific cortisol immunoassay. Clin Biochem 50:475–480. https://doi.org/10.1016/j.clinbiochem.2017.02.008
Javorsky BR, Raff H, Carroll TB et al (2021) New cutoffs for the biochemical diagnosis of adrenal insufficiency after ACTH stimulation using specific cortisol assays. J Endocr Soc 5:bvab022. https://doi.org/10.1210/jendso/bvab022
Grassi G, Morelli V, Ceriotti F et al (2020) Minding the gap between cortisol levels measured with second-generation assays and current diagnostic thresholds for the diagnosis of adrenal insufficiency: a single-center experience. Hormones (Athens) 19:425–431. https://doi.org/10.1007/s42000-020-00185-y
Grinspoon SK, Biller BM (1994) Clinical review 62: laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab 79:923–931. https://doi.org/10.1210/jcem.79.4.7962298