Long-Term Use of Oral and Inhaled Steroids Linked to Adrenal Insufficiency

Recent research has established a significant connection between the prolonged use of oral and inhaled corticosteroids and the risk of adrenal insufficiency. The findings were presented at the inaugural Joint Congress of the European Society of Paediatric Endocrinology (ESPE) and the European Society of Endocrinology (ESE).

According to the study, individuals who have been prescribed steroid tablets for over three months are more than six times as likely to be diagnosed with adrenal insufficiency compared to those using nonsteroidal anti-inflammatory drugs (NSAIDs). Furthermore, these patients face a heightened risk of hospitalization due to adrenal insufficiency. In contrast, while long-term inhaled steroid users also experience an increased likelihood of developing adrenal insufficiency, their risk of hospitalization is not significantly elevated.

Corticosteroids are commonly prescribed anti-inflammatory medications used to manage a range of conditions, including asthma, chronic obstructive pulmonary disease (COPD), allergies, arthritis, and autoimmune disorders. When patients are on these medications for over three weeks, it is critical to taper the dosage gradually. Stopping corticosteroids abruptly can lead to adrenal insufficiency, a condition where the adrenal glands do not produce sufficient cortisol, the stress hormone.

The study, conducted by a team from Rennes University Hospital in France, involved a thorough analysis of 558,667 individuals who had been using either oral or inhaled corticosteroids for a duration of three months to five years. The researchers compared these patients with those who were treated solely with NSAIDs. The results indicated that prolonged use of steroid tablets significantly increases both the diagnosis and hospitalization rates for adrenal insufficiency.

Lead researcher from Rennes University Hospital emphasized that their investigation is the largest to date examining the correlation between long-term corticosteroid use and the risk of adrenal insufficiency. Previous studies have primarily focused on the impact of corticosteroids on the pituitary gland, which regulates cortisol secretion from the adrenal glands. However, there is a notable lack of research regarding the incidence of adrenal insufficiency following chronic use of both oral and inhaled corticosteroids.

The findings also suggest that even low doses of inhaled steroids can contribute to adrenal insufficiency, a revelation that may challenge existing perceptions within the medical community. The presence of synthetic corticosteroids in the bloodstream can cause the adrenal glands to enter a dormant state, leading to decreased or halted cortisol production. Therefore, it is crucial that patients who require long-term corticosteroid therapy receive a supplementary treatment, such as hydrocortisone, when discontinuing their medication to prevent adrenal insufficiency and mitigate its potentially life-threatening consequences.

This research underscores the necessity for healthcare providers to consider alternative treatments and implement appropriate monitoring strategies for patients undergoing corticosteroid therapy to safeguard their health.