Adrenocortical Function During Intermittent Corticosteroid Therapy

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Abstract
Ten adult patients with the nephrotic syndrome were given corticosteroids on an intermittent regimen (3 consecutive days each week) for 12-18 months. The total cortisol equivalent dosage ranged from 34.6 - 57.6 g. Adrenocortical function was evaluated before and during treatment with basal (resting) plasma Porter-Silber chromogen (PSC) determinations and the standard ACTH test measuring the plasma PSC and urinary 17-KGS (ketogenic steroids) response. Results indicated normal adrenocortical function throughout, except for transitory suppression at 3 months. Average plasma PSC 60 hr. after withdrawal of steroid therapy showed a normal rebound response throughout suggesting normal pituitary-adrenal integrity. The findings suggest that not only total steroid dosage, but continuity of treatment influences suppression of endogenous cortisol production. Comparison of the present study with others previously reported indicated a need for pre- and post treatment measurement of adrenocortical function in the same patients in order to more precisely assess the suppressive effects of corticosteroids therapy. The clinical status of the nephrotic syndrome was improved in 4 of the patients treated with corticosteroids. Clinical hypercortisonism appeared in 9 of 10 cases, but appeared to be less marked than in other patients treated with continuous steroid therapy. Since normal adrenal function under non-stressful conditions is apparently maintained, and because fewer steroidal side effects have been observed, intermittent corticosteroid therapy may be indicated in disorders where such treatment has been determined effective.