Suppression of adrenal function by low-dose prednisone: assessment with 24-hour urinary steroid hormone profiles—a review of five cases

Alternative Medicine Review, March, 2006 by Patrick N. Friel, Thomas Alexander, Jonathan V. Wright

(16.) Arlt W, Callies F, van Vlijmen JC, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med 1999;341:1013-1020.

Patrick N. Friel, as--Forensic Toxicologist, Washington State Toxicology Laboratory.

Correspondence address: 2203 Airport Way South, Seattle, WA 98134 E-mail: Pat.Friel@wsp.wa.gov

Thomas Alexander, MD--Private practice, Tahoma Clinic, Renton, WA; Clinical Consultant, Meridian Valley Laboratory, Renton, WA.

Jonathan V. Wright, MD--Medical Director, Tahoma Clinic, Renton, WA; Medical Director, Meridian Valley Laboratory, Renton, WA.

Table 1. Glucocorticoid Levels in Subjects on Prednisone

Glucocorticoid         Reference Range         Women taking
                      ([micro]g/24 hr)   Prednisone (median, span)

Cortisol                   30-170              25 (8-38)
Cortisone                  31-209              18 (9-56)
Tetrahydrocortisone      1700-4200            191 (24-1628) *
Tetrahydrocortisol        900-2600            116 (17-579) *

* p = 0.03 (patient values compared to lower limit of reference range)

Table 2. DHEA and Metabolites in Subjects on Prednisone

Androgen               Reference Range         Women taking
                      ([micro]g/24 hr)   Prednisone (median, span)

DHEA                      100-2000               7 (1-8) *
Androsterone              500-3200             160 (30-333)
Etiocholanolone           500-5000             177 (70-384)

* p = 0.03 (patient values compared to lower limit of reference range)

Table 3. Corticosterone Metabolites in Subjects on Prednisone

Corticosterone Metabolite       Reference Range      Women taking
                                ([micro]g/24 hr)   Prednisone (median,
                                                         span)

Aldosterone                            6-25             6 (4-18)
Tetrahydrocorticosterone              30-240           66 (6-111)
allo-Tetrahydrocorticosterone        130-600           38 (6-218)

* p=0.03 (patient values compared to lower limit of reference range)