A HYPERCALCEMIC CRISIS FOLLOWING ABRUPT DISCONTINUATION OF LONG TERM ADRENAL STEROID THERAPY

ABSTRACT Pituitary-adrenal function was investigated in 23 patients with rheumatoid arthritis and in 19 patients with bronchial asthma following prolonged glucocorticoid therapy. The duration of continuous treatment varied from 2 months to 15 years and the total dose of steroids from 400 mg to 54 g of prednisolone or its equivalent. After treatment had been discontinued, pituitary ACTH-reserve was estimated by means of an oral metyrapone test and adrenal response to ACTH by means of an intravenous or intramuscular ACTH-test. The pituitary ACTH-response was evaluated by determining the increment in the excretion of 11-deoxy-17-hydroxycorticosteroids during the administration of the metyrapone blocking agent and adrenal response to ACTH by the excretion of 11-oxygenated corticosteroids. The reduction of the metyrapone and ACTH responses were found to be related to the duration of prednisolone treatment as well as to the daily and total administered dose, although a marked individual variation in several instances could be observed in the degree of suppression of endogenous ACTH or corticosteroid production. Deficient metyrapone and ACTH responses were more frequently encountered in bronchial asthma than in patients with rheumatoid arthritis who had received comparable doses of glucocorticoids during similar periods. No negative metyrapone tests, however, in either group of patients were obtained for 12 months or unless the total dose of steroids administered was at least 3.5 g of prednisolone or its equivalent. Most patients who showed reduced adrenocortical response to ACTH had received large total doses of corticosteroids and the lowest total dose on which a subnormal ACTH-response was observed was 6 g. The results demonstrate that both pituitary ACTH-reserve and adrenocortical response to ACTH can be reduced by long-term adrenal steroid therapy, although the loss of pituitary ACTH-response occurs earlier during the course of treatment.

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Severe Posaconazole-Induced Glucocorticoid Deficiency with Concurrent Pseudohyperaldosteronism: An Unfortunate Two-for-One Special

Journal of Fungi ◽

10.3390/jof7080620 ◽

2021 ◽

Vol 7 (8) ◽

pp. 620

Author(s):

Alejandro Villar-Prados ◽

Julia J. Chang ◽

David A. Stevens ◽

Gary K. Schoolnik ◽

Samantha X. Y. Wang

Keyword(s):

Mechanism Of Action ◽

Antifungal Agents ◽

Laboratory Findings ◽

Steroid Synthesis ◽

Adrenal Steroid ◽

History Of ◽

Glucocorticoid Deficiency

A 56-year-old Hispanic man with a history of disseminated coccidioidomycosis was diagnosed with persistent glucocorticoid insufficiency and pseudohyperaldosteronism secondary to posaconazole toxicity. This case was notable for unexpected laboratory findings of both pseudohyperaldosteronism and severe glucocorticoid deficiency due to posaconazole’s mechanism of action on the adrenal steroid synthesis pathway. Transitioning to fluconazole and starting hydrocortisone resolved the hypokalemia but not his glucocorticoid deficiency. This case highlights the importance of recognizing iatrogenic glucocorticoid deficiency with azole antifungal agents and potential long term sequalae.

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475 Prevalence of posterior subcapsular cataracts (PSC) in an asthmatic population undergoing long-term surveillance for adverse effects of inhaled steroid therapy

Journal of Allergy and Clinical Immunology ◽

10.1016/0091-6749(91)91758-l ◽

1991 ◽

Vol 87 (1) ◽

pp. 258 ◽

Cited By ~ 2

Author(s):

C DYSON ◽

D MCCORMICK ◽

J TOOGOOD

Keyword(s):

Adverse Effects ◽

Steroid Therapy

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Adrenal and Pituitary Functions during Long-Term Topical Steroid Therapy

Dermatology ◽

10.1159/000252115 ◽

1972 ◽

Vol 144 (3) ◽

pp. 179-186 ◽

Cited By ~ 9

Author(s):

J.C.M. Hendrikse ◽

A.J. Moolenaar

Keyword(s):

Steroid Therapy ◽

Topical Steroid ◽

Topical Steroid Therapy

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Long-term preserved renal function of a patient with mass-forming granulomatous interstitial nephritis by biopsy-based steroid therapy

Clinical and Experimental Nephrology ◽

10.1007/s10157-010-0336-6 ◽

2010 ◽

Vol 14 (6) ◽

pp. 625-629 ◽

Cited By ~ 3

Author(s):

Junji Yamauchi ◽

Yoshifumi Ubara ◽

Tatsuya Suwabe ◽

Masayuki Yamanouchi ◽

Noriko Hayami ◽

...

Keyword(s):

Renal Function ◽

Interstitial Nephritis ◽

Steroid Therapy ◽

Granulomatous Interstitial Nephritis

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ESTIMATION OF SEVERITY OF THE NEPHROTIC SYNDROME IN CHILDHOOD AS A GUIDE TO THERAPY AND PROGNOSIS

PEDIATRICS ◽

10.1542/peds.23.5.861 ◽

1959 ◽

Vol 23 (5) ◽

pp. 861-873

Author(s):

W. W. McCrory ◽

M. Rapoport ◽

D. S. Fleisher

Keyword(s):

Nephrotic Syndrome ◽

Hormone Therapy ◽

Small Group ◽

Clinical Response ◽

Steroid Therapy ◽

Prognostic Value ◽

Therapeutic Benefits ◽

Adrenocortical Hormone ◽

Glomerular Damage

The degree of clinical and biochemical improvement observed in 20 children with the nephrotic syndrome who received a similar course of adrenocortical steroid therapy has been correlated with the severity of the existing renal glomerular damage. It appears that the clinical response of children with nephrosis to hormone therapy and their behavior shortly thereafter can provide the physician with information of prognostic value at an earlier period in the course of the disease than has been possible heretofore. This was especially true in the case of patients destined to have a favorable outcome. The immediate and long-term therapeutic benefits obtained in a small group of patients with nephrosis, who received sufficient adrenocortical hormone therapy to induce and maintain maximal improvement in all measurable abnormalities, are superior to the results obtained by therapy aimed only at control of edema.

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