Photo Credit: magicmine

The following is a summary of “Changes in Adrenal Function and Insufficiency Symptoms After Cessation of Prednisolone,” published in the March 2025 issue of JAMA Network Open by Hansen et al. 

Glucocorticoid (GC) therapy can lead to GC-induced adrenal insufficiency (GIAI), though its prevalence and clinical impact are unclear. Further research is needed to better understand the condition. 

Researchers conducted a retrospective study to determine the prevalence and symptoms of GIAI.  

They conducted a cross-sectional multicenter study at 3 Danish hospitals, collecting baseline data from March 2021 to March 2024. Participants with polymyalgia rheumatica and/or giant cell arteritis were assessed a median of 39 (25-62) days after stopping prednisolone, which had a median duration of 13 (10-20) months. GIAI was defined as a plasma cortisol level less than 420 nmol/L after a 250 μg corticotropin test (SST). Secondary outcomes included symptoms assessed by the Addison disease-specific quality of life questionnaire (AddiQoL-30), body composition, and muscle function. 

The results showed that of 267 patients (145 female [55%]; median age 73 [68-78] years), 5 (1.9%; 95% CI, 0.8%-4.3%) had GIAI, and 75 (34%; 95% CI, 28%-41%) had symptoms of adrenal insufficiency, defined by an AddiQoL-30 score of 85 or lower. The symptomatic group had lower basal cortisol levels compared to the asymptomatic group (263 nmol/L; 95% CI, 242-283 nmol/L vs 309 nmol/L; 95% CI, 295-324 nmol/L; P < .001). Factors associated with a low AddiQoL-30 score included female sex (PR, 1.68; 95% CI, 1.13-2.51), increased body fat percentage (PR, 2.33; 95% CI, 1.21-4.50), reduced handgrip strength (PR, 2.71; 95% CI, 1.44-5.10), and low Short Physical Performance Battery score (PR, 2.78; 95% CI, 1.42-5.42). 

Investigators found a GIAI prevalence of 1.9% after prednisolone cessation, which was lower than previously reported. The high prevalence of symptoms and lower basal cortisol levels highlighted the clinical challenges of steroid withdrawal. 

Source: jamanetwork.com/journals/jamanetworkopen/fullarticle/2831668