Summary
Plasma cortisol levels and the response of the adrenal gland to 0.25 mg ACTH administration were measured in 12 patients receiving 15 mg or more of a short-acting steroid (fluocortolone or prednisone) on three out of four days, in 10 patients on daily steroid treatment (15 mg prednisone or more per day), and in 9 normal subjects. The basal plasma cortisol level of the first group was between that of patients on daily prednisone treatment and that of normal subjects. The adrenal function in patients on the three out of four day treatment schedule appeared to be slightly diminished, yet still within the accepted limits for adrenals capable of responding adequately to stress. The adrenal function proved insufficient in all patients on daily steroids. The three out of four day steroid regimen thus offers a solution with many advantages over continuous steroid treatment for patients refractory to the alternate-day schedule.
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Abbreviations
- AIHA:
-
autoimmune hemolytic anemia
- F:
-
fluocortolone
- HPA:
-
hypothalamo-pituitary-adrenal axis
- MS:
-
multiple sclerosis
- P:
-
prednisone
- PRCA:
-
pure red cell anemia
- SLE:
-
systemic lupus erythematosus
References
Ackerman GL, Nolan CM (1968) Adrenocortical responsiveness after alternate day corticosteroid therapy. N Eng J Med 278:405–409
Axelrod L (1976) Glucocorticoid therapy. Medicine 55:39–65
Byyny RL (1976) Withdrawal from glucocorticoid therapy. N Engl J Med 295:30–32
Gerhards E, Nieuweboer B (1969) Über Stoffwechsel und Stoffwechselwirkungen des Fluocortolon. Fluorcortolon-Symposium Berlin, Saladruck, Berlin, pp 20–26
Graber AL, Ney RL, Nicholson WE, Island DP, Liddle GW (1965) Natural history of pituitary-adrenal recovery following long-term suppression with corticosteroids. J Clin Endocrin Metab 25:11–16.
Kehlet H, Blichert-Toft M, Lindholm J, Rasmussen P (1975) Short ACTH test in assessing hypothalamic-pituitary-adrenocortical function. Br Med J 1:249–251
Kehlet H, Binder C (1973) Value of an ACTH test in assessing hypothalamic-pituitary-adrenocortical function in glucocorticoid-treated patients. Br Med J 2:147–149
LeClercq R, Copinsh G, Franckson JRM (1969) Le dosage par compétition du cortisol plasmatique, modification de la méthode de Murphy. Rev Etudes Clin Biol XIV:811–819
Liddle GW (1981) Pharmacologic use of ACTH and steroids as anti-inflammatory and immunosuppressive agents. In: RH Williams (ed) Textbook of Endocrinology, pp 288–290, WB Saunders, Philadelphia
MacGregor RR, Sheagren JN, Lipsett MB, Wolff SM (1969) Alternate-day prednisone therapy: Evaluation of delayed hypersensitivity responses, control of disease and steroid side effects. N Engl J Med 280:1427
Maberly DJ, Gibson GJ, Butler AG (1973) Recovery of adrenal function after substitution of beclomethasone dipropiomate for oral corticosteroids. Br Med J 1:778–782
Miescher PA, and Beris PH (1984) Immunosuppressive therapy in the treatment of autoimmune diseases. Springer Semin Immunopathol 7:69–90
Morris HG, Neuman I, Ellis EF (1974) Plasma steroid concentration during alternate-day treatment with prednisone. J Allergy Clin Immunol 54:350–358
Soyka LF, Saxena KN (1965) Alternate-day steroid therapy for nephrotic children. JAMA 192:225–230
Soyka LF (1967) Treatment of nephrotic syndrome in childhood: use of alternate-day prednisone regimen. Am J Dis Child 113:693–701
Steroid therapy and the adrenals (editorial) Lancet 2:537–538 (1975)
Taeuber U, Haack D, Nieuweboer B, Kloss G, Vecset P, Wendt H (1984) The pharmakokinetics of fluocortolone and prednisolone after intravenous and oral administration. Int J Clin Pharmacol Ther Toxicol 22:48–55
Wood JB, Frankland AW, James VHT, Landon J (1965) A rapid test of adrenocortical function. Lancet 1:243–245
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Beris, P., Burger, A., Favre, L. et al. Adrenocortical responsiveness after discontinuous corticosteroid therapy. Klin Wochenschr 64, 70–75 (1986). https://doi.org/10.1007/BF01784132
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DOI: https://doi.org/10.1007/BF01784132