Supplementary table for: A retrospective study on weaning glucocorticoids and recovery of the hypothalamic-pituitary-adrenal axis

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.ObjectiveInvestigate HPA axis recovery in patients on long-term prednisolone and assess outcome after hydrocortisone conversion.DesignRetrospective cohort study.SettingOutpatient endocrine steroid clinic.PatientsPatients on long-term prednisolone referred for HPA axis testing between 2015-2022.Main outcomes measured1) HPA axis recovery rate in patients on prednisolone demonstrated by normal ACTH stimulation test (AST).2) HPA axis recovery rate sub-analysis of dose-matched patients with confirmed tertiary AI on prednisolone or hydrocortisone.Results206 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%). HPA axis recovery rate in dose-matched prednisolone and hydrocortisone conversion groups was 7/10 (70%) and 2/13 (15%) (p=0.008), respectively. There was no difference in mean (SD) age (67.1(12.2) v 63.4(11.1) years; p=0.464) and baseline cortisol (5.3(4.2) v 4.6(3.1)µg/dL; p=0.648) and median [IQR] glucocorticoids duration (1213[1114] v 2316[4808] days; p=0.693) and baseline ACTH (20.5[29.0] v 16.3[14.8]ng/L; p=0.905) between dose-matched prednisolone and hydrocortisone groups. Follow-up duration in prednisolone group was significantly lower (median [IQR] 348[975] v 667[884] days; p=0.012).ConclusionsPatients 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.

在糖皮质激素抑制下，下丘脑-垂体-肾上腺（HPA）轴功能受损，导致三级肾上腺皮质功能减退（AI）。在患者逐渐脱离糖皮质激素治疗的过程中，关于是否维持患者使用泼尼松龙或转换为氢化可的松尚无共识。研究目标在于探究长期使用泼尼松龙患者的HPA轴恢复情况，并评估转换为氢化可的松后的临床效果。研究设计为回顾性队列研究。研究场所为门诊内分泌激素诊所。研究对象为2015至2022年间因HPA轴检测而长期使用泼尼松龙的患者。主要观察指标包括：1）泼尼松龙治疗患者中，通过正常ACTH刺激试验（AST）所体现的HPA轴恢复率；2）对泼尼松龙或氢化可的松治疗且确诊为三级AI的剂量匹配患者进行亚组分析。研究结果：206名泼尼松龙治疗患者接受了三级AI的检测，其中176名患者继续使用泼尼松龙，30名患者转换为氢化可的松。泼尼松龙治疗后，间隔测试后患者的HPA轴恢复率为137/206（66.5%）。泼尼松龙与氢化可的松转换组中剂量匹配的患者的HPA轴恢复率分别为7/10（70%）和2/13（15%）（p=0.008）。在剂量匹配的泼尼松龙组和氢化可的松组中，平均（标准差）年龄（67.1(12.2) vs 63.4(11.1)岁；p=0.464）、基线皮质醇（5.3(4.2) vs 4.6(3.1)µg/dL；p=0.648）、中位数[四分位数间距]糖皮质激素使用持续时间（1213[1114] vs 2316[4808]天；p=0.693）和基线ACTH（20.5[29.0] vs 16.3[14.8]ng/L；p=0.905）之间均无显著差异。泼尼松龙组的随访时间显著较短（中位数[四分位数间距] 348[975] vs 667[884]天；p=0.012）。结论：长期使用泼尼松龙且患有糖皮质激素诱导的AI的患者，在逐渐脱离治疗过程中，可以恢复HPA轴功能。转换为每日多次剂量的氢化可的松治疗，在恢复HPA轴功能方面未见明显优势。