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. 2013 Jul 24;8(7):e68713.
doi: 10.1371/journal.pone.0068713. Print 2013.

Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study

Yvan Jamilloux  1 , Eric Liozon, Gregory Pugnet, Sylvie Nadalon, Kim Heang Ly, Stephanie Dumonteil, Guillaume Gondran, Anne-Laure Fauchais, Elisabeth Vidal
Affiliations

Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study

Yvan Jamilloux et al. PLoS One. .

Abstract

Objectives: Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency.

Subjects and design: 150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared.

Results: At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05).

Conclusion: Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians' vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart of the study population.
GCA: giant cell arteritis, T1 to T4: ACTH tests 1–4.
See this image and copyright information in PMC

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