ArticleThe Journal of clinical endocrinology and metabolism2024
A Retrospective Study on Weaning Glucocorticoids and Recovery of the Hypothalamic-Pituitary-Adrenal Axis.
Article in The Journal of clinical endocrinology and metabolism, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 10 citations in OpenAlex.
- European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency.The Journal of clinical endocrinology and metabolism · 2024Guideline
- Changes in Adrenal Function and Insufficiency Symptoms After Cessation of Prednisolone.JAMA network open · 2025Trial
- A clinician's guide to corticosteroid therapy in pneumonia and critical illness: agent selection, dosing, monitoring, and interactions.Pneumonia (Nathan Qld.) · 2026Review
- Defining a serum cortisol cutoff level post-CRH stimulation for diagnosing ACTH deficiency: A retrospective study validated by a nationwide registry.Frontiers in endocrinology · 2026Article
- Weaning patients off long-term prednisolone: a survey of physicians' practice in the UK and Southeast Asia.BMJ open · 2025Article
- Rapid Adrenal Atrophy Following Excision of an Ectopic Adrenocorticotropin-Secreting Lung Carcinoid Tumor.JCEM case reports · 2025Article
- Practical guidance for stopping glucocorticoids.Australian prescriber · 2025Review
- Impact of hydrocortisone vs prednisone therapy on postsurgical recovery in patients with endogenous hypercortisolism: a prospective cohort study.European journal of endocrinology · 2025Article
- New guidelines on glucocorticoid-induced adrenal insufficiency: the end of short synacthen test in rheumatology?RMD open · 2025Article
- A Retrospective Study on Weaning Glucocorticoids and Recovery of the Hypothalamic-Pituitary-Adrenal Axis.The Journal of clinical endocrinology and metabolism · 2024Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
contextGlucocorticoids suppress the hypothalamic-pituitary-adrenal (HPA) axis, resulting in tertiary adrenal insufficiency (AI). When weaning patients off glucocorticoids there is no consensus on whether to maintain patients on prednisolone or convert to hydrocortisone.
objectiveTo investigate HPA axis recovery in patients on long-term prednisolone and assess outcome after hydrocortisone conversion.
methodsThis was a retrospective cohort study at an outpatient endocrine steroid clinic. Patients were on long-term prednisolone and referred for HPA axis testing between 2015 and 2022. The main outcomes measured were (1) HPA axis recovery rate in patients on prednisolone demonstrated by a normal adrenocorticotrophic hormone (ACTH) stimulation test (AST) and (2) HPA axis recovery rate subanalysis of dose-matched patients with confirmed tertiary AI on prednisolone or hydrocortisone were measured.
resultsIn total, 206 patients on prednisolone were tested for tertiary AI. Of these, 176 remained on prednisolone while 30 were converted to hydrocortisone. The overall HPA axis recovery rate for patients on prednisolone after interval testing was 137/206 (66.5%). The HPA axis recovery rate in dose-matched prednisolone and hydrocortisone conversion groups was 7/10 (70%) and 2/13 (15%) (P = .008), respectively. There was no difference in mean (SD) age (67.1 [12.2] vs 63.4 [11.1] years; P = .464) and baseline cortisol (5.3 [4.2] vs 4.6 [3.1] µg/dL; P = .648) and median [interquartile, IQR] glucocorticoid duration (1213 [1114] vs 2316 [4808] days; P = .693) and baseline ACTH (20.5 [29.0] vs 16.3 [14.8] ng/L; P = .905) between dose-matched prednisolone and hydrocortisone groups. Follow-up duration in the prednisolone group was significantly lower (median [IQR] 348 [975] vs 667 [884] days; P = .012).
conclusionPatients with glucocorticoid-induced AI maintained on once-daily prednisolone can recover HPA axis function when weaning. There is no apparent advantage to recover HPA axis function in converting to multiple-dosing hydrocortisone.
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