Summary
In 20 patients we studied the function of the corticotropic pituitary and adrenal gland 13 to 45 month (m=27.1) after heart transplantation (HTx). For prophylactic immunosuppression all patients were treated with tripple drug therapy, including Cyclosporine A, Azathioprin and Prednisolone. After performing the CRH-test we could demonstrate, that in all patients, treated with Prednisolone (0.09–0.15 mg/kg/day) for more than 1 year, adrenal insufficiency was evident. Patients must be controlled carefully, if therapy with steroids is stopped thereafter, not only because of increased risk of rejection but also because metabolic disturbance caused by adrenal insufficiency may occur. In case of elevated demand of steroids (i.e. infections or surgery), adequate substitution with glucocorticosteroids is needed.
Zusammenfassung
Bei allen Patienten nach Herztransplantation, die mit einer dreifachen immunsuppressiven Therapie unter Einschluß von Glucocorticoiden behandelt werden, muß nach einer Therapiedauer von über einem Jahr mit der Suppression der Hypothalamus-HVL-NNR-Achse gerechnet werden. Daraus ergeben sich Konsequenzen für die Überwachung in Situationen während und nach erhöhtem Steroidbedarf sowie bei der Beendigung der Steroidtherapie.
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Abbreviations
- HTx:
-
Herztransplantation
- HVL:
-
Hypophysenvorderlappen
- NNR:
-
Nebennierenrinde
- ALG:
-
Antilymphocytenglobulin
- ATG:
-
Antithymocytenglobulin
- OKT3-AK:
-
orthoklone T3-Antikörper
- hCRH:
-
humanes Cortico-Releasing-Hormon
- RIA:
-
Radio-Immuno-Assay
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Hummel, M., Warnecke, H., Schüler, S. et al. Risiko der Nebennierenrindeninsuffizienz nach Herztransplantation. Klin Wochenschr 69, 269–273 (1991). https://doi.org/10.1007/BF01666853
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DOI: https://doi.org/10.1007/BF01666853