Can glucocorticoid therapy cause adrenal insufficiency in adults?

Source:

Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review

Rebecca M. Joseph, MSc, Ann Louise Hunter, MBChB, MRCP, David W. Ray, MBChB, FRCP, PhD, William G. Dixon, MRCP, PhD

Summary

This study looked at the relationship between glucocorticoid (GC) therapy and adrenal insufficiency (AI) in adults. The authors concluded that there is evidence of AI at different doses and durations of treatment with GCs and therefore physicians should test for AI in all patients taking GCs. 

Some background

Glucocorticoids (GCs) such as prednisone (Deltasone) or prednisolone (Orapred, Millipred) can help to control inflammation, decreasing pain, swelling, and stiffness in the joints. For these reasons, GCs are often prescribed for rheumatoid arthritis (RA). However, GCs can stop the adrenal gland from producing sufficient levels of a hormone called cortisol. This leads to a condition known as adrenal insufficiency (AI). Symptoms of AI include fatigue and nausea while severe cases can be fatal.

The link between GC treatment and risk of AI is unclear. The authors of this study looked at rates of AI across different doses and treatment durations of GCs. They also looked at AI in patients who have reduced or stopped GC treatment altogether. 

Methods & findings

The authors looked at 73 different studies to examine the link between glucocorticoids and AI. These included a total of 3166 patients who had been exposed to GC treatment. The most common GCs across all studies were prednisone, prednisolone and budesonide (Pulmicort).

Across all studies an average of 37.4% of patients had adrenal insufficiency.

Nine studies showed that 10 weeks after withdrawal from GC treatment, AI was present in up to 75% of patients. 3 years after withdrawal, AI was still present in up to 15% of patients.

There was no significant association between the dose or treatment duration and rate of AI in patients.

Conclusion

The authors concluded that AI is present in patients taking glucocorticoids regardless of treatment dose or duration. Screening for AI in all patients receiving GC treatment should be considered. 

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