E076 Incidence of adrenal insufficiency in patients with giant cell arteritis tapering glucocorticoids with the Norwich prednisolone regimen

Abstract

Abstract Background/Aims Glucocorticoids continue to be the main treatment for giant cell arteritis (GCA). It is widely recognised that treatment with oral glucocorticoids is associated with adverse events including adrenal insufficiency. Reports suggest the risk of adrenal insufficiency is dependent on the dose and the duration of therapy. The Norwich regimen has been devised to deliver prednisolone at a rate 1mg/kg of lean body mass tapering over 100 weeks. We report the incidence of adrenal insufficiency related to the Norwich regimen. Methods The Norwich regimen has been used in all patients diagnosed with GCA from 01/01/2012. A notes review of all patients diagnosed after that date was undertaken to look for evidence of adrenal insufficiency. We routinely check 9am cortisol when symptoms of adrenal insufficiency were reported. The 9am cortisol was recorded as normal, indeterminate, or low. Patients with a low 9am cortisol remained on long term prednisolone; no further test was required. Patients with an indeterminate result were referred for a short synacthen test (SST). If the results of the SST were normal patients were weaned off prednisolone, patients with an inadequate SST result remained on long term prednisolone. Results From 01/01/2012-31/05/2022 353 patients diagnosed with GCA were treated with the Norwich regimen. 9am cortisol was checked in 76 patients (21.5%). Of these, 34 patients (9.6%) had a normal result, 35 patients (9.9%) had an indeterminate result requiring SST. 7 patients (2.0%) had a low 9am cortisol. Of the 35 patients referred for SST: 27 patients (7.6%) had an adequate result, 8 patients (2.3%) had an inadequate result resulting in long term prednisolone. Conclusion We report the incidence of adrenal insufficiency in patients diagnosed with GCA, tapering prednisolone using the Norwich regimen. In total 15/353 (4.3%) patients developed adrenal insufficiency because of long-term glucocorticoid use. Disclosure G. Ducker: None. C.B. Mukhtyar: None.