Hypothalamo-pituitary-adrenocortical function during and after steroid therapy: recent data and critical review

Prolonged corticosteroid treatment is considered to be the main cause bf ad renal insufficiency < Al >. Al is due to adrenal atrophy caused by the inhi bition of ACTH secretion. Risk factors for Al after corticosteroid treatmen t remain unknown. Various functional tests, particularly the much less than standard much greater than Synacthene 250 mug, demonstrate frequent abnorm al responses in these patients. However, these abnormalities are not predic tive of the risk of Al in particular in case of stress. More recent tests ( CRH, much less than low dose much greater than Synacthene) need to be furth er evaluated in this situation. Several recent studies in animals and in hu mans have demonstrated that the need for glucocorticoid coverage during a s urgical stress has been greatly overestimated and that maintenance of the u sual daily dose seems to be sufficient and safe in most patients with minor surgical stress. Revision of guidelines for more important surgical stress or for other medical conditions in patient treated with glucocorticoids is necessary.