| BackgroundGlucocorticoids have important physiological and pharmacological effects and are widely used in clinical treatment of various inflammations and autoimmune diseases.Glucocorticoid therapy has side effects and has become one of the important causes of secondary adrenal insufficiency.At present,the domestic and foreign opinions on when the adrenal insufficiency occurs early in the application of glucocorticoids are not uniform.Therefore,this article aims to explore the relationship between early application of different doses of glucocorticoid therapy and adrenal insufficiency,and to provide evidence for early detection of adrenal insufficiency and the use of corticotropin to prevent adrenal insufficiency.ObjectiveTo study the time of early adrenal insufficiency during treatment with different doses of glucocorticoids.Methods1.Research objectProspective analysis of 35 children with nephrotic syndrome,Henoch-Sch?nlein purpura nephritis,and Henoch-Sch?nlein purpura who were hospitalized in the second ward of the Pediatric Internal Medicine Department of the First Affiliated Hospital of Xinxiang Medical University from April 2019 to March 2021,and 20 children with control group.According to the "Guiding Principles for the Clinical Application of Glucocorticoids" published in the Chinese Journal of Endocrinology and Metabolism in 2012,the glucocorticoid dose is converted to prednisone.The prednisone dose is 0.5mg～1.0mg/kg/d as the medium-dose group,a total of 9 cases;prednisone dose>1.0mg/kg/d and the maximum dose of 60mg/d are the high-dose group,a total of 26 cases.2.Detect the concentration of COR and ACTHThe concentrations of serum cortisol and plasma adrenocorticotropic hormone were measured before glucocorticoid application(D0),day 3(D3),and day 7(D7)from 06:00 to08:00 in the morning.When the cortisol concentration is less than or equal to 3μg/dl,the adrenal cortex is considered to be insufficiency.Healthy children served as a control group,blood was drawn from 06:00 to 08:00 in the morning to determine the concentration of cortisol and adrenocorticotropic hormone.3.Statistical processingUse SPSS 23.0 software for data processing.Continuous variables are evaluated by Shapiro-Wilk test to determine whether they conform to the normal distribution.Measurement data conforming to the normal distribution are expressed as the mean±standard deviation,and the non-normal distribution is expressed as the interquartile range.The comparison between groups is by t test.One-way analysis of variance was used for comparison,and repeated-measure analysis of variance was used to show the relationship between glucocorticoid administration time and adrenal insufficiency.Spearman correlation analysis was used to show the relationship between glucocorticoid cumulative dose and adrenal cortex hypofunction.The enumeration data used the chi-square test,and the Fisher exact probability method was used to express the relationship between the percentage of adrenal insufficiency,and the difference was statistically significant with P<0.05.Results1.20 cases in the control group,12 males and 8 females,aged(7.30±2.00)years old;9 cases in the medium-dose group,6 males and 3 females,aged(9.33±3.00)years old,and26 cases in the high-dose group,there were 18 males and 8 females,aged(6.52±3.41)years old.There was no statistically significant difference in gender comparison between the control group,medium-dose group,and high-dose group(χ2=0.433,P=0.805).There was no significant difference in age comparison between the control group,medium-dose group and high-dose group(F=3.142,P=0.052).2.In the medium-dose group,COR and ACTH concentrations were measured on D3 and D7 in 6 cases and 9 cases respectively,of which 6 cases were tested continuously for 3times.In the high-dose group,the COR and ACTH concentrations were measured on D3 and D7 in 19 cases and 20 cases respectively,of which 13 cases were tested continuously for 3 times.The COR concentrations measured at D0 in the control group,medium-dose group,and high-dose group were(13.21±5.60)μg/dl,11.80(9.78,14.25)μg/dl,and 10.09(9.28,16.62)μg/dl.Comparison between groups,the difference was not statistically significant(P>0.05);the ACTH concentrations measured at D0 in the control group,medium-dose group,and high-dose group were(26.07±11.31)pg/dl,24.80(16.35,47.4)pg/dl,22.35(15.05,43.02)pg/dl respectively,there was no statistically significant difference between groups(P>0.05).3.In the medium-dose group D3,the measured COR concentration was 5.98(5.17,7.22)μg/dl,and the ACTH concentration was 19.20(17.42,24.12)pg/dl.Compared with the concentration of COR and ACTH at D0,the difference was statistically significant(P<0.05).On D7,the concentration of COR was 4.88(1.52,6.87)μg/dl,and the concentration of ACTH was 10.07(6.34,17.2)pg/dl.Compared with the concentration of COR and ACTH measured at D0,the difference was statistically significant(P<0.01);There was no statistically significant difference in the concentration of COR and ACTH measured on D3 and D7(P>0.05).4.In the high-dose group D3,the COR concentration was 6.41(4.30,10.00)μg/dl,and the ACTH concentration was 13.90(11.10,23.50)pg/dl.Compared with COR at D0,the difference was statistically significant(P<0.01),compared with ACTH at D0,the difference was statistically significant(P<0.05);At D7,the concentration of COR was 1.44(1.00,3.50)μg/dl,and the concentration of ACTH was 9.91(6.07,15.77)pg/dl.Compared with the concentrations of COR and ACTH at D0,the difference was statistically significant(P<0.01);The difference between COR measured on D3 and D7 was statistically significant(P<0.01),and the difference between ACTH measured on D3 and D7 was not statistically significant(P>0.05).5.Comparison between groups: there was no statistically significant difference between the medium-dose group and the high-dose group in the measurement of COR and ACTH on D3(P>0.05);there was no significant difference in COR and ACTH between the medium-dose group and the high-dose group at D7(P>0.05).6.In the medium-dose group,adrenal insufficiency was 0% at D3,and at D7 adrenal insufficiency was 44.4%(4/9);in the high-dose group,adrenal insufficiency was 21.1%(4/19)at D3,and at D7 the adrenal insufficiency was 70.0%(14/20).There was no statistically significant difference in the incidence of adrenal insufficiency on D3 and D7 between the medium-dose group and the high-dose group(P>0.05).Conclusions 1.The adrenal insufficiency induced by glucocorticoids is significantly correlated with glucocorticoids exposure dose and time.2.Adrenal insufficiency may occur on the 7th day of medium-dose glucocorticoid treatment.On the 3rd day of high-dose glucocorticoid treatment,some children have adrenal insufficiency,and 70% of children have adrenal insufficiency on the 7th day. |
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