Research suggests clinicians should be vigilant in identifying adrenal insufficiency even in patients on low levels of glucocorticoids

Research led by Rebecca Joseph at the NIHR Manchester Musculoskeletal Biomedical Research Unit has found evidence that demonstrates adrenal insufficiency at all levels of glucocorticoid exposure, even low dosage.

Patients with inflammatory diseases such as rheumatoid arthritis are often prescribed glucocorticoids, a steroid used to control pain and swelling. Adrenal insufficiency is a possible side effect of the long-term use of steroids. This is when the adrenal glands do not produce enough of the hormone cortisol, in response to stressful situations such as exercise or injury. Cortisol has metabolic and immune effects and people who produce inadequate amounts may become unwell or collapse.

The research team set out to summarise current knowledge of the prevalence and recovery of glucocorticoid-induced adrenal insufficiency from the 73 studies that have been published on this matter, including data from 3,166 patients.

From reviewing the papers, researchers found the variation in indications and glucocorticoid type, dose and duration over sixty years of published literature made it difficult to answer the specific research questions. However there was evidence that adrenal insufficiency can persist for more than three years after glucocorticoid withdrawal and in those receiving low dosage.

Dr Will Dixon, Senior Clinical Lecturer, Centre for Musculoskeletal Research, The University of Manchester explained:

The diversity of studies and variability in results makes it difficult to answer the questions with confidence; however our research does raise questions for clinicians prescribing glucocorticoid therapy.

We found evidence that demonstrates adrenal insufficiency at all levels of glucocorticoid exposure, even low dosage and after tapering. We therefore suggest that clinicians be vigilant for adrenal insufficiency at all degrees of glucocorticoid exposure and counsel patients accordingly.

Read the systemic glucocorticoid therapy and adrenal insufficiency in adults: a systematic review paper in full via the Seminars in Arthritis and Rheumatism Journal.