All Corticosteroid Users at Risk for Adrenal Insufficiency

All patients using corticosteroid therapy are at risk for adrenal insufficiency, and clinicians should educate patients about this risk.

Although the proportion of patients with adrenal insufficiency after treatment of corticosteroids varies, researchers found that there is no administration form, disease, dose group or treatment duration for which adrenal insufficiency can be safely excluded, according to data published in the Journal of Clinical Endocrinology & Metabolism.

“Therapy with corticosteroids is targeted towards inhibition of an inflammatory response. However, the use of corticosteroids is associated with numerous side effects and considered to be the most common cause of adrenal insufficiency,” the researchers wrote.

“Given the high prevalence of corticosteroid users, it is of great clinical relevance to try to obtain knowledge about the risk of developing adrenal insufficiency.”

For the study, the researchers conducted a systematic review and meta-analysis to evaluate the percentage of patients who develop adrenal insufficiency after corticosteroid use. Seventy-four articles with a total of 3,753 participants were included in the analysis.

When evaluated by corticosteroid administration form, data indicated that the percentages of patients with adrenal insufficiency ranged from 4.2% for nasal administration (95% CI, 0.5-28.9) to 52.2% for intra-articular administration (95% CI, 40.5-63.6).

Similarly, when stratified by disease, percentages varied widely, from 6.8% for asthma with inhalation corticosteroids only (95% CI, 3.8-12.0) to 60% for6 hematological malignancies (95% CI, 38.0-78.6).

Results also demonstrated variation in risk according to dose, the researchers reported, with percentages ranging from 2.4% for low dose (95% CI, 0.6-9.3) to 21.5% (95% CI, 12.0-35.5) for high dose. The same was observed for treatment duration, with percentages ranging from 1.4% (95% CI, 0.3-7.4) for less than 28 days to 27.4% (95% CI, 17.7-39.8) for more than 1 year in patients with asthma.

“In conclusion, this study demonstrates that all patients using corticosteroid therapy are at risk for adrenal insufficiency,” the researchers wrote. “This implicates that clinicians should 1. inform patients about the risk and symptoms of adrenal insufficiency, 2. consider testing patients after cessation of high dose or long-term treatment with corticosteroids, and 3. display a low threshold for testing especially in those patients with nonspecific symptoms after cessation.”


  1. Broersen LHA et al. J Clin Endocrinol Metab. 2015;doi:10.1210/jc.2015-1218.