Evidence mapPaperPMID 40100216Full record

Trial reportJAMA network open2025

Changes in Adrenal Function and Insufficiency Symptoms After Cessation of Prednisolone.

Simon Bøggild Hansen, Anja Fenger Dreyer, Nanna Thurmann Jørgensen, Hajir Al-Jorani, Lise Sofie Bislev, Victor Brun Boesen, Stina Willemoes Borresen, Louise Lehmann Christensen, Dorte Glintborg, Ellen Margrethe Hauge and 15 more

Abstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Asthma and corticosteroids "Frontiers in allergy · 2026
    Review
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors.

Simon Bøggild HansenAarhus University Hospital, Department of Endocrinology and Internal Medicine, Aarhus, Denmark.
Anja Fenger DreyerOdense University Hospital, Department of Endocrinology, Odense, Denmark.
Nanna Thurmann JørgensenUniversity of Copenhagen, Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen, Denmark.
Hajir Al-JoraniOdense University Hospital, Department of Endocrinology, Odense, Denmark.
Lise Sofie BislevAarhus University Hospital, Department of Endocrinology and Internal Medicine, Aarhus, Denmark.
Victor Brun BoesenCopenhagen University Hospital, Rigshospitalet, Department of Nephrology and Endocrinology, Copenhagen, Denmark.
Stina Willemoes BorresenCopenhagen University Hospital, Rigshospitalet, Department of Nephrology and Endocrinology, Copenhagen, Denmark.
Louise Lehmann ChristensenOdense University Hospital, Department of Endocrinology, Odense, Denmark.
Dorte GlintborgOdense University Hospital, Department of Endocrinology, Odense, Denmark.
Ellen Margrethe HaugeAarhus University, Department of Clinical Medicine, Aarhus, Denmark.
Merete Lund HetlandUniversity of Copenhagen, Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen, Denmark.
Richard Christian JensenOdense University Hospital, Department of Endocrinology, Odense, Denmark.
Søren Andreas JustSvendborg Hospital-Odense University Hospital, Department of Medicine, Section of Rheumatology, Svendborg, Denmark.
Kresten Krarup KellerAarhus University, Department of Clinical Medicine, Aarhus, Denmark.
Marianne KloseCopenhagen University Hospital, Rigshospitalet, Department of Nephrology and Endocrinology, Copenhagen, Denmark.
Kristina LaugesenAarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark.
Henning LochtCopenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.
Marie Louise LundCopenhagen University Hospital, Rigshospitalet, Department of Nephrology and Endocrinology, Copenhagen, Denmark.
Jelena StankovicAarhus University Hospital, Department of Endocrinology and Internal Medicine, Aarhus, Denmark.
Paul M StewartUniversity of Leeds, Faculty of Medicine and Health, Leeds, United Kingdom.
Randi Maria Hanghøj TeiAarhus University Hospital, Department of Endocrinology and Internal Medicine, Aarhus, Denmark.
Anne VossOdense University Hospital, Department of Rheumatology, Odense, Denmark.
Ulla Feldt-RasmussenUniversity of Copenhagen, Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen, Denmark.
Jens Otto L JørgensenAarhus University Hospital, Department of Endocrinology and Internal Medicine, Aarhus, Denmark.
Marianne Skovsager AndersenOdense University Hospital, Department of Endocrinology, Odense, Denmark.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: The widespread use of glucocorticoid (GC) therapy may result in GC-induced adrenal insufficiency (GIAI), but the prevalence and clinical implications remain uncertain. Objective: To ascertain the prevalence and symptoms of GIAI. Design, Setting, and Participants: Cross-sectional multicenter study at 3 Danish hospitals. Baseline data were collected March 2021 to March 2024 from an ongoing randomized clinical trial. Participants were patients with polymyalgia rheumatica and/or giant cell arteritis who were investigated a median (IQR) of 39 (25-62) days after planned cessation of prednisolone treatment. Exposure: Prednisolone treatment a median (IQR) of 13 (10-20) months in duration. Main outcomes and measures: Primary outcome GIAI was defined as a stimulated plasma cortisol level less than 420 nmol/L in response to a short 250 μg corticotropin test (SST). Secondary outcomes were adrenal insufficiency symptoms assessed by the Addison disease-specific quality of life questionnaire (AddiQoL-30), body composition, and muscle function. Results: Of 267 patients included (145 female [55%]; median [IQR] age 73 [68-78] years), 5 (1.9%; 95% CI, 0.8%-4.3%) had GIAI, whereas 75 (34%; 95% CI, 28%-41%) had symptoms compatible with adrenal insufficiency defined by an AddiQoL-30 score 85 or lower (symptomatic group). The symptomatic group had lower basal cortisol levels compared with the asymptomatic group (263 nmol/L; 95% CI, 242-283 nmol/L vs 309 nmol/L; 95% CI, 295-324 nmol/L; P < .001). Factors associated with a low AddiQoL-30 score included female sex (prevalence ratio [PR], 1.68; 95% CI, 1.13-2.51), increased body fat percentage (PR, 2.33; 95% CI, 1.21-4.50), reduced handgrip strength (PR, 2.71; 95% CI, 1.44-5.10) and low Short Physical Performance Battery score (PR, 2.78; 95% CI, 1.42-5.42). Conclusions and Relevance: This cross-sectional study of 267 patients with polymyalgia rheumatica or giant cell arteritis found a GIAI prevalence of 1.9% after cessation of prednisolone. This is much lower than previously reported and speaks against routine screening, which should be restricted to patients with overt symptoms. The high prevalence of symptoms of adrenal insufficiency in association with lower basal cortisol levels substantiate the clinical challenges of steroid withdrawal and merit future research.

Indexed as

Adrenal InsufficiencyGiant Cell ArteritisGlucocorticoidsPolymyalgia RheumaticaPrednisoloneAgedCross-Sectional StudiesDenmarkFemaleHumansHydrocortisoneMalePrevalenceQuality of LifeGlucocorticoidsHydrocortisonePrednisolone

Identifiers

PMID40100216
PMCPMC11920843

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.