Recovery of steroid induced adrenal insufficiency

Younes, Areej K.; Younes, Noor K.

doi:10.21037/tp.2017.10.01

Cited by 46 publications

(53 citation statements)

References 22 publications

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“…For these reasons, the LDCT is now preferred. The LDCT must be done by people well-informed in the preparation and the administration of the 1 μ g Cortrosyn [ 10 ]. To ensure appropriate testing at our CHUM clinic, the hospital pharmacist is responsible for preparing the Cortrosyn syringe and the nurse uses this preparation to perform the test.…”

Section: Methodsmentioning

confidence: 99%

Adrenal Insufficiency in Cystic Fibrosis: A Rare Phenomenon?

Préville-Ratelle

Coriati

Ménard

et al. 2018

Canadian Respiratory Journal

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Background The prevalence of adrenal insufficiency (AI) in cystic fibrosis (CF) is unknown. The frequent use of glucocorticoids (inhaled or systemic) may induce the long-term suppression of the hypothalamic-pituitary-adrenal axis. Methods We reviewed the results of adrenocorticotropic hormone (ACTH) stimulation tests done over a 10-year period to evaluate adrenal function in 69 CF patients of the CHUM CF clinic. Clinical characteristics of AI patients were compared to adrenal-sufficient (AS) patients. Results AI was confirmed in 33 of the 69 CF patients. A higher rate of dysglycemia (P=0.022) and of Aspergillus positive culture (P=0.006) was observed in AI patients compared to AS patients. Weight, CFTR genotype, and pulmonary function were comparable between AI and AS patients. The use of systemic corticosteroids (SC) prior to the diagnosis of AI was observed in 42.4% of patients. Compared to AI patients without SC, SC-treated AI patients were older and had a higher rate of allergic bronchopulmonary aspergillosis. Conclusion This study is the first to systematically examine the presence of AI in the largest cohort of CF patients studied to date with a prevalence of 8%. Patients treated with corticosteroids and those colonized with Aspergillus have a greater risk of AI.

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Section: Methodsmentioning

confidence: 99%

Adrenal Insufficiency in Cystic Fibrosis: A Rare Phenomenon?

Préville-Ratelle

Coriati

Ménard

et al. 2018

Canadian Respiratory Journal

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“…The most common serious SCS-associated comorbidities include osteoporosis and osteopenia, type II diabetes, obesity, cardiovascular disorders and adrenal suppression. In addition, use of SCS has been associated with psychiatric symptoms such as insomnia, mania, anxiety or aggressive behaviour, dyspeptic disorder, hypertension, dyslipidaemia, infections, muscle atrophy, cataracts, glaucoma, bruising, change in physical appearance, skin striae and change in appetite [20][21][22].…”

Section: Use Of Scs In Asthma Managementmentioning

confidence: 99%

Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety

Price¹,

Castro²,

Bourdin³

et al. 2020

Eur Respir Rev

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Short courses of systemic corticosteroids (SCS), both oral and injectable, are very effective for the resolution of acute asthma symptoms, including exacerbations. However, the benefits of SCS, even short courses, must be balanced against the impact of their side-effects. While the adverse consequences of long-term use are widely recognised, there appears to be a perception in the medical community that short courses of SCS are safe. Limited but growing evidence in the literature suggests that even very brief dosing periods (3–7 days) of SCS are enough to cause significantly negative outcomes for patients. Short courses of SCS are associated with increased risk of adverse events including loss of bone density, hypertension and gastrointestinal ulcers/bleeds, in addition to serious impacts on mental health. Strategies to improve asthma control are recommended, including: 1) as-needed combination therapies in mild asthma; 2) risk factor reduction; 3) improving adherence/inhaler technique; 4) earlier initiation of add-on therapies; 5) use of biologics in appropriate patients; 6) development of new therapies to better control the disease; and 7) widespread education of the medical community. We propose that patients and primary care physicians should consider a cumulative SCS dose of 1 g per year as a highly relevant and easy-to-recall threshold.

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“…Patients with rheumatoid arthritis may be on long-term steroids. This can lead to secondary adrenal insufficiency due to a reduction of adrenocorticotrophic hormone stimulation of the adrenal glands (Younes & Younes 2017). Stopping exogenous steroids may lead to dangerously low steroid levels, causing adrenal crisis (Puar et al 2016).…”

Section: Intraoperative Managementmentioning

confidence: 99%

Perioperative management of patients with rheumatoid arthritis undergoing orthopaedic surgery

Agarwal

Kamaraj

McDonnell

et al. 2019

Journal of Perioperative Practice

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Rheumatoid arthritis is an autoimmune disease which is characterised by systemic inflammation. In the recent decades, the advent of disease modifying anti-rheumatic drugs have reduced the need for orthopaedic procedures. However, there are numerous patients in which pharmacological treatment fails and these patients require surgical intervention. Complications can arise due to the underlying pathology and multitude of medications these patients can be on, specifically increased infection rates due to use of immunosuppressive agents. An understanding into the disease itself, as well as perioperative management, may improve overall patient outcomes and prevent future complications.

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Recovery of steroid induced adrenal insufficiency

Cited by 46 publications

References 22 publications

Adrenal Insufficiency in Cystic Fibrosis: A Rare Phenomenon?

Adrenal Insufficiency in Cystic Fibrosis: A Rare Phenomenon?

Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety

Perioperative management of patients with rheumatoid arthritis undergoing orthopaedic surgery

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