Advertisement

Pituitary adrenal recovery following short-term suppression with corticosteroids

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      To provide clinical guidelines for the use of high-dose short-term glucocorticoid therapy, we studied recovery of the hypothalamicpituitary-adrenal axis in 10 normal men following the administration of suppressive doses of prednisone (25 mg twice daily for five days). Cortisol responses to insulin-induced hypoglycemia and synthetic ACTH before treatment were compared with responses two and five days after concluding the prednisone course when adrenal function was not influenced by the presence of exogenous steroid. Two days after prednisone therapy, peak cortisol responses to both hypoglycemia (11.0 ± 0.9 μg/dl mean ± SEM) and synthetic ACTH (13.3 ± 1.4 μg/dl) were significantly reduced compared to pretreatment (20.6 ± 1.6 and 27.3 ± 2.5 μg/dl, respectively, p < 0.001). Five days after concluding the prednisone therapy, peak cortisol response to hypoglycemia had returned to near pretreatment levels although peak cortisol response in the adrenal gland to synthetic ACTH (22.3 ± 1.1 μg/dl) remained reduced (p < 0.05). These data suggest that brief courses of high-dose prednisone therapy may limit the adrenal component of the hypothalamic-pituitary-adrenal response to stress for up to five days.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Melby J
        Systemic corticosteroid therapy: pharmacology and endocrinologic considerations.
        Ann Intern Med. 1974; 81: 505
        • Christy N
        • Wallace E
        • Jailer J
        Comparative effects of prednisone and of cortisone in suppressing the response of the adrenal cortex to exogenous adrenocorticotropin.
        J Clin Endocrinol Metab. 1956; 16: 1059
        • Plager J
        • Cushman P
        • Chase A
        Suppression of pituitaryACTH response in man by administration of ACTH or cortisol.
        J Clin Endocrinol Metab. 1962; 22: 147
        • Grant S
        • Forsham P
        • Diraimondo V
        Suppression of 17-hydroxycorticosteroids in plasma and urine by single and divided doses of triamcinolone.
        N Engl J Med. 1965; 273: 1115
        • Nichols T
        • Nugent C
        • Tyler F
        Diurnal variation of suppression of adrenal function by glucocorticoids.
        J Clin Endocrinol Metab. 1965; 25: 343
        • Myles A
        • Bacon P
        • Daly J
        Single daily dose corticosteroid treatment.
        Ann Rheum Dis. 1971; 30: 149
        • Naysmith A
        • Hancock B
        • Cullen D
        • et al.
        Pituitary function in patients receiving intermittent cytotoxic and corticosteroid therapy for malignant lymphoma.
        Lancet. 1976; 1: 715
        • Harter JG
        Corticosteroids: their physiologic use in allergic disease.
        NY State J Med. 1966; 66: 827
        • Moses A
        • Miller M
        Assessment of pituitary reserve in subjects pretreated with dexamethasone.
        Metabolism. 1969; 18: 376
        • Osterman P
        • Wide L
        The insulin tolerance test after pretreatment with dexamethasone.
        Acta Endocrinologica. 1976; 83: 341
        • Von Werder K
        • Hane S
        • Forsham P
        Suppression of the hypothalamo-pituitary-adrenal axis and growth hormone release with dexamethasone.
        Horm Metab Res. 1971; 3: 171
        • Nakagawa K
        • Horivchi Y
        • Mashimo K
        Response of plasma growth hormone and corticosteroids to insulin and arginine with or without prior administration of dexamethasone.
        J Clin Endocrinol Metab. 1969; 29: 35
        • Copinschi G
        • L'Hermite M
        • Leclercq R
        • et al.
        Effects of glucocorticoids on pituitary hormonal responses to hypoglycemia. Inhibition of prolactin release.
        J Clin Endocrinol Metab. 1975; 40: 442
        • Axelrod L
        Glucocorticoid therapy.
        Medicine (Baltimore). 1976; 55: 39
        • Meikle A
        • Tyler F
        Potency and duration of action of glucocorticoids. Effects of hydrocortisone, prednisone, and dexamethasone on human pituitary-adrenal function.
        Am J Med. 1977; 63: 200
        • Schalch D
        • Parker M
        A sensitive double antibody immunoassay for human growth hormone in plasma.
        Nature(Lond). 1964; 203: 1141
        • Silber R
        • Porter C
        Determination of 17,21 dehydroxy-20-keto-steroids in urine and plasma.
        J Biol Chem. 1954; 210: 923
        • Landon J
        • Wynn V
        • James V
        The adrenocortical response to insulin induced hypoglycemia.
        J Endocrinol. 1963; 27: 183
        • Greenwood F
        • Landon J
        • Stamp T
        The plasma sugar, free fatty acid, cortisol, and growth hormone response to insulin. I. In control subjects.
        J Clin Invest. 1966; 45: 429
        • Wood J
        • James V
        • Frankland A
        • et al.
        A rapid test of adrenocortical function.
        Lancet. 1965; 1: 243
        • Greig W
        • Browning M
        • Boyle J
        • et al.
        Effect of the synthetic polypeptide B1–24 (synacthen) on adrenocortical function.
        J Endocrinol. 1966; 34: 411
        • Daly J
        • Myles A
        • Bacon P
        • et al.
        Pituitary adrenal function during corticosteroid withdrawal in rheumatoid arthritis.
        Ann Rheum Dis. 1967; 26: 18
        • Malone D
        • Grant I
        • Percy-Robb I
        Hypothalamic-pituitary-adrenal function in asthmatic patients receiving long-term corticosteroid therapy.
        Lancet. 1970; 2: 733
        • Livanou T
        • Ferriman D
        • James V
        Recovery of hypothalamo-pituitary-adrenal function after corticosteroid therapy.
        Lancet. 1967; 2: 856
        • Jacobs H
        • Nabarro J
        Tests of hypothalamic-pituitary-adrenal function in man.
        Q J Med. 1969; 38: 475
        • Donald R
        • Espiner E
        The plasma cortisol and corticotropin release to hypoglycemia following adrenal steroid and ACTH administration.
        J Clin Endocrinol Metab. 1975; 41: 1
        • Landon J
        • James V
        • Wharton M
        • et al.
        Threshold adrenocortical sensitivity in man and its possible application to corticotropin bioassay.
        Lancet. 1967; 2: 697
        • Salassa RM
        • Bennett WA
        • Keating FR
        • et al.
        Postoperative adrenocortical insufficiency.
        JAMA. 1953; 152: 1509
        • Wilson K
        • Gray C
        • Cameron E
        Hypothalamic pituitary adrenal function in patients treated with intermittent high dose prednisone and cytotoxic chemotherapy.
        Lancet. 1976; 1: 610
        • Melby JC
        Assessment of adrenocortical activity in man following steroid therapy.
        ACTA Endocrinol. 1960; 35: 347
        • Graber A
        • Ney R
        • Nicholson W
        • et al.
        Natural history of pituitary-adrenal recovery following long-term suppression with corticosteroids.
        J Clin Endocrinol Metab. 1965; 25: 11
        • Kehlet H
        • Blichert-Toft M
        • Lindholm J
        Short ACTH test in assessing hypothalamic-pituitary-adrenal function.
        Br Med J. 1976; 1: 249
        • Kehlet H
        • Binder C
        Value of an ACTH test in assessing hypothalamic-pituitary-adrenocortical function in glucocorticoid treated patients.
        Br Med J. 1973; 2: 147
        • Ackerman G
        • Nolan C
        Adrenocortical responsiveness after alternate day corticosteroid therapy.
        N Engl J Med. 1968; 278: 405