Patients using corticosteroids for various conditions may be at risk for developing adrenal insufficiency, according to recent findings.

In the systematic review and meta-analysis, Leonie H. A. Broerson, BSc, of Leiden University Medical Center in the Netherlands, and colleagues searched numerous databases in February 2014 for studies pertaining to adrenal insufficiency in adult corticosteroid users. Studies eligible for inclusion included randomized clinical trials, cohort studies and cross-sectional studies.

The researchers defined the meta-analysis’ main outcomes as the pooled percentages of patients with adrenal insufficiency after corticosteroid treatment, grouped by delivery method, disease, treatment dose and treatment duration. A random effects logistic regression model was used to pool percentages.

The researchers found that when stratified by administration method, the proportion of patients with adrenal insufficiency ranged from 4.2% for nasal administration to 52.2% for administration to the joints. When grouped by disease, the risk for adrenal insufficiency ranged from 6.8% for patients with asthma using inhalation corticosteroids only to 60% for hematologic cancers.

Risk for adrenal insufficiency ranged from 2.4% for low-dose to 21.4% for high dose when stratified by dose. When grouped by treatment duration, the risk for adrenal insufficiency ranged from 1.4% for 28 days’ duration to 27.4% for 1 years in patients with asthma only.

“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.” – by Jennifer Byrne