{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T23:57:24Z","timestamp":1786579044825,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Patients with rheumatic diseases are often treated with prolonged, high\u2010dose systemic glucocorticoids which can cause hypothalamic\u2010pituitary\u2010adrenal (HPA) axis suppression and development of tertiary adrenal insufficiency. Adrenal insufficiency carries the risk of serious, potentially life\u2010threatening adrenal crisis. Our study evaluated the prevalence, characteristics and recovery of patients with underlying rheumatology conditions who had received prolonged glucocorticoid treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and patients<\/jats:title><jats:p>Retrospective, cross\u2010sectional study. We evaluated 238 patients seen in outpatient rheumatology clinic, managed in accordance with current nationally and internationally accepted clinical guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Data collected included patient demographics, historical steroid data, 09.00\u00a0h cortisol\/short synacthen test (SST) results and follow\u2010up data on those with repeat assessments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 65% of our cohort had a 09.00\u00a0h cortisol &lt;350\u00a0nmol\/L. On SST, 43% of patients demonstrated evidence of possible tertiary adrenal insufficiency.<\/jats:p><jats:p>Prednisolone equivalent dose at time of SST was significantly higher in the group who failed SST vs. those who passed; mean of 5.57\u00a0mg vs. 3.59mg (<jats:italic>p\u00a0=\u00a0<\/jats:italic>.005). 09.00\u00a0h cortisol result correlated with 30\u2010min cortisol on SST (<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a0.20, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.002). 0\u2010min cortisol on SST correlated more strongly with 30\u2010min cortisol than 09.00\u00a0h cortisol (<jats:italic>R<jats:sup>2<\/jats:sup><\/jats:italic>\u00a0=\u00a0.59, <jats:italic>p<\/jats:italic>\u2010value\u00a0&lt;\u00a0.001). Patients with 0\u2010min cortisol &gt;350\u00a0nmol\/L, all passed their SST.<\/jats:p><jats:p>Patients who remained on prednisolone were more likely to recover (71%) vs. those switched to hydrocortisone (27%), <jats:italic>P<\/jats:italic>\u00a0=\u00a0.02. Peak steroid dose was predictive of recovery; significantly lower in those who recovered (mean of 22.3\u00a0mg vs. 33.8\u00a0mg, <jats:italic>P\u00a0=\u00a0<\/jats:italic>.03). Steroid duration was not found to be a predictor of recovery [recovery (64.2\u00a0months) vs. non\u2010recovery (55.6\u00a0months), <jats:italic>P\u00a0=\u00a0<\/jats:italic>.58]. There was no correlation found to outcome on SST with age, sex, peak steroid dose, steroid duration, underlying rheumatological condition, additional exogenous steroid use or serum sodium.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Forty three percent of our patients demonstrated sub\u2010optimal adrenal function on SST. Steroid dose at the time of SST was the only significant predictive risk factor for tertiary adrenal insufficiency. 09.00\u00a0h cortisol demonstrated good correlation with outcome on SST and could represent a valid screening test to reduce need for SST if 09.00\u00a0h &gt;350\u00a0nmol\/L. Further prospective data are required to further characterize risk factors, predictive features of recovery and establish optimal management strategy of steroids (prednisolone vs hydrocortisone) to encourage adrenal recovery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14405","type":"journal-article","created":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:23:02Z","timestamp":1609201382000},"page":"361-370","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Evaluating tertiary adrenal insufficiency in rheumatology patients on long\u2010term systemic glucocorticoid treatment"],"prefix":"10.1111","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7972-3321","authenticated-orcid":false,"given":"Rebecca","family":"Sagar","sequence":"first","affiliation":[{"name":"Leeds Centre for Diabetes and Endocrinology Leeds Teaching Hospitals Trust Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Mackie","sequence":"additional","affiliation":[{"name":"School of Medicine University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"W. Morgan","sequence":"additional","affiliation":[{"name":"School of Medicine University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Stewart","sequence":"additional","affiliation":[{"name":"Leeds Centre for Diabetes and Endocrinology Leeds Teaching Hospitals Trust Leeds UK"},{"name":"School of Medicine University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afroze","family":"Abbas","sequence":"additional","affiliation":[{"name":"Leeds Centre for Diabetes and Endocrinology Leeds Teaching Hospitals Trust Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"779","volume-title":"Textbook of Rheumatology","author":"Alexrod L","year":"1993"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep303a"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ker017"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1053\/sarh.2003.49993"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-20-0361"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12865"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-10-200411160-00007"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-00153"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14963"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2016.03.001"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-01317"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keaa011"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0608"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-1218"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0068713"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.14405","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cen.14405","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.14405","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T06:23:31Z","timestamp":1693635811000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cen.14405"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,11]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1111\/cen.14405"],"URL":"https:\/\/doi.org\/10.1111\/cen.14405","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,11]]},"assertion":[{"value":"2020-10-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-11","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}