Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review.
Objectives The aim of this systematic literature review was to summarize the current knowledge regarding the prevalence of, time to recovery from, and influence of glucocorticoid dose and duration on glucocorticoid-induced adrenal insufficiency (AI). Methods Eligible studies were original research a...
| Publicado en: | Seminars in Arthritis & Rheumatism Vol. 46; no. 1; pp. 133 - 142 |
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| Autores principales: | , , , |
| Formato: | research systematic review Journal Article |
| Publicado: |
W B Saunders
Aug2016
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121784377&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 121784377 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00490172 4GQ jtl: Seminars in Arthritis & Rheumatism issn: 00490172 maglogo: N pubinfo: dt: Aug2016 vid: 46 iid: 1 pid: 1351 pub: W B Saunders place: Philadelphia, Pennsylvania artinfo: ui: 121784377 121784377 121784377 10.1016/j.semarthrit.2016.03.001 121784377 ppf: 133 ppct: 9 formats: tig: atl: Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review. aug: au: Joseph, Rebecca M. Hunter, Ann Louise Ray, David W. Dixon, William G. affil: NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK sug: subj: Glucocorticoids Therapeutic Use Adrenal Insufficiency Chemically Induced Glucocorticoids Adverse Effects Adult Human Prednisolone Prevalence Systematic Review Medline Adrenal Glands Physiology Glucocorticoids Administration and Dosage Bias (Research) Prednisolone Administration and Dosage Adrenal Insufficiency Prevention and Control Adult: 19-44 years ab: Objectives The aim of this systematic literature review was to summarize the current knowledge regarding the prevalence of, time to recovery from, and influence of glucocorticoid dose and duration on glucocorticoid-induced adrenal insufficiency (AI). Methods Eligible studies were original research articles, which included adult patients with an indication for glucocorticoids and measured adrenal function following exposure to systemic glucocorticoids. Searches were performed in Web of Science and MEDLINE, with further articles identified from reference lists. Screening was performed in duplicate. Data were extracted for each group of glucocorticoid-exposed patients within eligible studies. The reported proportion of patients with AI was summarized as median and inter-quartile range. Results were then stratified by daily dose, cumulative dose, duration of exposure and time since last glucocorticoid use. The risk of bias within and across studies was considered: for randomised controlled trials risk of bias was assessed using the tool developed by the Cochrane Collaboration. Results Overall, 73 eligible studies were identified out of 673 screened. The percentage of patients with AI ranged from 0% to 100% with a median (IQR) = 37.4% (13–63%). Studies were small—median (IQR) group size 16 (9–38)—and heterogeneous in methodology. AI persisted in 15% of patients retested 3 years after glucocorticoid withdrawal. Results remained widely distributed following stratification. AI was demonstrated at <5 mg prednisolone equivalent dose/day, <4 weeks of exposure, cumulative dose <0.5 g, and following tapered withdrawal. Conclusions The heterogeneity of studies and variability in results make it difficult to answer the research questions with confidence based on the current literature. There is evidence of AI following low doses and short durations of glucocorticoids. Hence, clinicians should be vigilant for adrenal insufficiency at all degrees of glucocorticoid exposure. pubtype: Academic Journal doctype: research systematic review Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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