Validity of the 1μg Cosyntropin Stimulation Test in Comparison with the Insulin Tolerance Test for the Diagnosis of Adrenal Insufficiency in Patients with Liver Transplant after Corticosteroid Withdrawal

Presentation Number: SUN 402
Date of Presentation: April 2nd, 2017

Stéfanie Parisien-La Salle*1, Jessica Moramarco2, Évelyne Labrèche1, Jean-Hugues Brossard1, Marc Dorais3, Marc Martin1, Catherine Vincent1 and Agnes Rakel1
1Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada, 2Hôpital Charles-Le Moyne, Longueuil, QC, Canada, 3StatSciences Inc, Montréal, QC, Canada

Abstract

Glucocorticoids in combination with immunosuppressive drugs are used as the initial regimen in patients following liver transplantation to limit rejection(1). Suppression of the hypothalamic-pituitary-adrenal (HPA) axis is a well-known consequence following the use of glucocorticoids. The insulin tolerance test (ITT) is the gold standard for the diagnosis of adrenal insufficiency(2). The 1μg Cosyntropin stimulation test (CST) is often used to determine if the axis has recovered, however its validity has not yet been established in the transplant population. The objective of this study was to verify if a normal response to the 1μg CST (peak cortisol > 500 nmol/L) predicts a normal response to the ITT (peak cortisol > 550 nmol/L) in a cohort of liver transplant patients weaned off prednisone. Patients were recruited when the daily dose of prednisone reached 5 mg and a plasmatic morning cortisol reached 200 nmol/L. Prednisone was discontinued and a 1 μg CST was performed. If the CST was normal, an ITT was obtained. If the CST was abnormal, a CST was repeated every four months until normalization, point at which an ITT was obtained. Eight of the 13 patients (61.5%) did not reach a peak cortisol above 550 nmol/L at the ITT despite having a normal CST. However, there was no statistical difference between the peak cortisol in the CST and the peak cortisol in the ITT (p=0.055). Moreover, neither time on corticosteroids (p=0.414), time lapse between cessation of prednisone and a normal CST (p=0.315) or cumulative steroid dose (p=0.707) could predict peak ITT cortisol. In conclusion, the demonstration of the recovery of the HPA axis in liver transplanted patients after steroid withdrawal cannot rely on the 1μg CST.

 

Nothing to Disclose: SP, JM, ÉL, JHB, MD, MM, CV, AR