Real-world evidence links long-term use of oral and inhaled steroids to adrenal insufficiency

Individuals taking steroid tablets for more than 3 months are over 6 times more likely to be diagnosed with adrenal insufficiency than those treated with nonsteroidal anti-inflammatory drugs, according to research presented at the first Joint Congress between the European Society of Paediatric Endocrinology (ESPE) and the European Society of Endocrinology (ESE). In addition, they have a greater risk of being hospitalized for adrenal insufficiency, while long-term users of inhaled steroids have an increased risk of developing adrenal insufficiency but without any increase in the number of hospitalizations. The findings highlight the importance of using an appropriate substitute treatment, such as hydrocortisone, in order to prevent the onset of adrenal insufficiency.

Steroids, also called corticosteroids, are anti-inflammatory medicines used to treat various conditions such as asthma, chronic obstructive pulmonary disease (COPD), allergies, arthritis and autoimmune diseases. When taking these widely-prescribed medicines, such as prednisolone, for more than three weeks, the dose has to be reduced gradually because abruptly stopping them can cause the adrenal gland to stop producing the stress hormone cortisol—a condition known as adrenal insufficiency.

In this study, Dr. Patricia Vaduva and colleagues from France examined 558,667 individuals who used steroid tablets or inhaled steroids for 3 months to 5 years, and compared them to individuals treated only with nonsteroidal anti-inflammatory drugs (NSAIDs). The researchers found that those who used steroid tablets for more than 3 months were over 6 times more likely to be diagnosed with adrenal insufficiency and over 3 times more likely to be hospitalized for adrenal insufficiency than those who only used NSAIDs. Similarly, those who took inhaled steroids had a 55% higher risk of being diagnosed with adrenal insufficiency, but did not have an increased risk of being hospitalized for the same condition.

“Our real-world study is the largest to investigate the association between long-term corticosteroid use and adrenal insufficiency,” said lead author Dr. Patricia Vaduva from the Rennes University Hospital in France.

“The impact of corticosteroids on the pituitary gland—located in the brain and which regulates adrenal gland cortisol secretion—has been previously looked at, but studies on the incidence of adrenal insufficiency following the chronic use of both oral and inhaled corticosteroids are practically lacking.”

Dr. Vaduva added, “Our findings show that even low doses of inhaled steroids can lead to adrenal insufficiency, contrary to what one might have thought until now. This information should be widely spread across the medical community.”

“The presence of synthetic corticosteroids in the blood can cause the adrenal glands to go into a ‘sleep-like’ state, where they reduce or stop producing cortisol. Therefore, when long-term corticosteroid therapy is stopped suddenly, a substitutive treatment with a naturally-occurring steroid like hydrocortisone is needed to avoid adrenal insufficiency and its potential life-threatening consequences. This will allow patients to be safe and will prevent numerous hospitalizations,” said Dr. Vaduva.

Provided by
European Society of Endocrinology