Effect of a 14-day course of systemic corticosteroids on the hypothalamic-pituitary-adrenal-axis in patients with acute exacerbation of chronic obstructive pulmonary disease

BMC Pulm Med. 2008 Jan 26;8:1. doi: 10.1186/1471-2466-8-1.

Abstract

Background: As supra-physiological intake of corticosteroids is a well known risk factor for the development of adrenal insufficiency, we investigated the function of the hypothalamic-pituitary-adrenal (HPA) axis during a 14-day course of systemic corticosteroids in patients with acute exacerbation of chronic obstructive pulmonary disease using clinical and laboratory measures.

Methods: A systematic clinical and laboratory assessment including measurement of basal cortisol levels and the response to low dose (1 mug) ACTH stimulation was performed in nine patients before, on the first and the last day of treatment, as well as 2, 7 and 21 days after corticosteroid withdrawal.

Results: At baseline, all nine patients had normal responses to 1 mug ACTH. On the first day of steroid treatment, 78% had a blunted peak cortisol response. This percentage increased to 89% after 14 days of steroid treatment. 78%, 33% and 33% of the patients had a blunted cortisol response to ACTH 2, 7, and 21 days after corticosteroid withdrawal, respectively. ROC curve analysis revealed that only basal cortisol concentrations (AUC 0.89), but not ACTH concentrations (AUC 0.49) or clinical signs (AUC 0.47) were predictive of an impaired function of the HPA axis. Basal cortisol levels of > 400 and < 150 nmol/l were 96% and 100% sensitive for a normal or pathological response to the ACTH stimulation test, respectively.

Conclusion: Immediate and prolonged suppression of the HPA axis is a common finding in otherwise asymptomatic patients undergoing systemic steroid treatment for acute exacerbation of chronic obstructive pulmonary disease and can reliably be assessed with the low-dose ACTH test.

MeSH terms

  • Adrenal Insufficiency / chemically induced
  • Adrenocorticotropic Hormone / blood
  • Aged
  • Aged, 80 and over
  • Diagnostic Techniques, Endocrine
  • Female
  • Glucocorticoids / administration & dosage*
  • Humans
  • Hydrocortisone / blood
  • Hypothalamo-Hypophyseal System / drug effects*
  • Luminescent Measurements
  • Male
  • Methylprednisolone Hemisuccinate / administration & dosage*
  • Middle Aged
  • Pituitary-Adrenal System / drug effects*
  • Prednisone / administration & dosage*
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology*
  • ROC Curve
  • Recovery of Function
  • Sensitivity and Specificity
  • Time Factors

Substances

  • Glucocorticoids
  • Methylprednisolone Hemisuccinate
  • Adrenocorticotropic Hormone
  • Prednisone
  • Hydrocortisone