ADRENAL INSUFFICIENCY AFTER GLUCOCORTICOID TREATMENT OF GIANT CELL ARTERITIS
Authors: A. Hočevar et al.
Little is known about adrenal insufficiency upon treatment of GCA with glucocorticoids (GC). Residual/relapsing polymyalgic symptoms resemble Addison’s-Syndrome. A differentiation between the two entities is important.
This French group analysed 74 GCA patients in whom discontinuation of GC therapy was planned. Adrenal insufficiency was defined as cortisol level <450 nmol/l measured 30 minutes after corticotropin stimulation test (CST). GC withdrawal was intended after a median of 13.5 (12.9 – 22.4) months of GC therapy, the mean (SD) prednisolone dose, prior to substitution with hydrocortisone and subsequent CST, was 3.1 (1.6) mg. Adrenal insufficiency was detected in 36/74 patients (48.6%); additionally, 10/74 patients (13.5%) had a borderline CST result.
Adrenal insufficiency is common and generally underestimated. In clinical practice it may be difficult to differentiate between Morbus Addison and persisting/relapsing polymyalgic symptoms. A CST might help in differentiation and guiding treatment. It is also important to inform patients about potential inadequate adrenal response in situations of stress.