From the Guidelines
Yes, inhaled corticosteroids (ICS) can cause adrenal insufficiency.
Adrenal Insufficiency Risk with ICS
- The risk of adrenal insufficiency with ICS is dose-dependent and can occur at commonly prescribed doses 1.
- Studies have shown that ICS can suppress the hypothalamic-pituitary-adrenal axis, leading to adrenal insufficiency 1.
- The DICE study established the dose of six different ICS products that rendered similar degrees of hypothalamic-pituitary-adrenal axis suppression, providing evidence for the potential of ICS to cause adrenal insufficiency 1.
- Patients treated with ICS should be monitored for potential steroid side effects, including adrenal suppression 1.
Key Points
- Adrenal insufficiency can occur with ICS use, even at recommended doses.
- The risk is dose-dependent and can be minimized with proper dosing and monitoring.
- Patients with asthma, bronchiectasis, and other conditions treated with ICS should be aware of the potential risk of adrenal insufficiency.
- Regular monitoring for signs of adrenal insufficiency, such as fatigue, weight loss, and hypotension, is essential for patients taking ICS.
From the Research
Adrenal Insufficiency and Inhaled Corticosteroids
- Inhaled corticosteroids (ICS) have been associated with an increased risk of adrenal insufficiency (AI) in various studies 2, 3, 4, 5.
- The risk of AI appears to be dose-dependent, with higher doses of ICS increasing the risk of AI 3, 5.
- Studies have shown that ICS use can suppress the endogenous production of glucocorticosteroids, leading to adrenal suppression (AS) and potentially AI 2, 6.
- AI can present with a range of symptoms, from mild fatigue to life-threatening acute adrenal crises 2, 4.
Patient Risk Factors
- Children and patients using high doses of ICS are at a higher risk of developing AI 2, 4, 6.
- Patients with chronic airway diseases, such as COPD or asthma, may also be at increased risk of AI due to ICS use 5.
- Systemic steroid users and those with higher Charlson comorbidity index (CCI) scores may be at increased risk of AI due to ICS use 5.
Screening and Management
- Screening for AI in select patient groups, such as those using high doses of ICS, is recommended 2.
- Initial screening can be done using early morning serum cortisol levels, with further testing (e.g. low-dose corticotropin stimulation test) if results are abnormal 2.
- Close monitoring of high-risk patients and minimization of ICS dose to the lowest effective level can help reduce the risk of AI 6.