Previous studies have found that taking formulated herb drugs may reduce the serum cortisol level which may result in an adrenal insufficiency. We suspect that this effect is induced by corticosteroids artificially mixed in formulated herb drugs. The objectives of this study were to determine the time course of serum cortisol and plasma ACTH (adrenocorticotropic hormone) levels, and whether pituitary-adrenal function recovers after quitting formulated herb drugs for a period of one year. Forty eight subjects with an initial serum cortisol level smaller than 10.7 μg/dL due to the intake of formulated herb drugs were recruited. They were tested for serum cortisol and plasma ACTH levels at 08:00 6, 9 and 12 months after quitting formulated herb drugs, respectively. The diagnosis of adrenal insufficiency was confirmed by an ACTH test at 9 months and 12 months after quitting the formulated herb drugs. The follow-up rates ranged from 63% to 71%. The 08:00 serum cortisol levels at the initial test, 6 months, 9 months, and 12 months were 4.4 ± 0.5 μg/dL, 6.6 ± 0.8 μg/dL, 6.6 ± 0.7 μg/dL, 6.2 ± 0.8 μg/dL, respectively, (interpersonal p = 0.0001, intrapersonal p = 0.0004, repeated measured ANOVA test). The 08:00 plasma ACTH levels at the initial test, 6 months, 9 months and 12 months were 33.8 ± 6.4 pg/mL, 67.6 ± 16.8 pg/mL, 21.0 ± 3.2 pg/mL, 16.3 ± 2.2 pg/mL, respectively (interpersonal P = 0.0001, intrapersonal P = 0.0003, repeated measured ANOVA test). The statistical significance was the same after logarithmic transformation of the ACTH levels. The positive rate of the ACTH test at 9 months and 12 months was approximately 60%. Among those who recovered, plasma ACTH usually reached a peak and serum cortisol level rose gradually in comparison with those who had negative ACTH tests. A combination of serum cortisol level <6.4 μg/dL and plasma ACTH level <25.4 pg/mL 6 months after quitting formulated herb drugs gives a specificity of 0.93 and a sensitivity of 0.58 to predict the persistence of pituitary-adrenal insufficiency one year after quitting formulated herb drugs. As comprised elderly, it is suggested that one of the reasons why 40% of our subjects did not recover was their age (average: 56.2 ± 9.0 y/o).
|Journal||Journal of the Formosan Medical Association|
|Issue number||SUPPL. 4|
|Publication status||Published - 1993 Dec 1|
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