Long-Term Use of Steroids Associated with Increased Risk of Adrenal Insufficiency: New Real-World Evidence

Recent research presented at the joint congress of the European Society of Paediatric Endocrinology and the European Society of Endocrinology has highlighted significant health risks linked to prolonged use of corticosteroid medications, including both oral and inhaled forms. The study analyzed data from over half a million individuals and found that those who used steroid tablets continuously for more than three months were over six times more likely to develop adrenal insufficiency compared to individuals taking nonsteroidal anti-inflammatory drugs (NSAIDs). Moreover, long-term users of inhaled steroids also exhibited a 55% increased likelihood of being diagnosed with adrenal insufficiency.

Adrenal insufficiency occurs when the adrenal glands fail to produce adequate amounts of cortisol, a vital stress hormone. Corticosteroids are widely prescribed for conditions such as asthma, chronic obstructive pulmonary disease (COPD), allergies, arthritis, and autoimmune disorders. However, their prolonged use can suppress the body's natural cortisol production by causing the adrenal glands to enter a dormant-like state. This suppression can persist even after stopping medication, necessitating proper management to prevent severe consequences.

The study's lead researcher, Dr. Patricia Vaduva from Rennes University Hospital in France, emphasized that even low doses of inhaled corticosteroids can contribute to adrenal suppression. She noted that the current findings underscore the importance of using appropriate substitute treatments, such as hydrocortisone, to mitigate risks and prevent potentially life-threatening adrenal crises. The research highlights the critical need for clinicians to be aware of the long-term impacts of corticosteroids and to implement proper tapering protocols and replacement therapies when discontinuing treatment.

The findings also shed light on the often-underestimated risks associated with inhaled steroids, suggesting that their safety profile may need reevaluation in light of their possible contribution to adrenal suppression. Patients on long-term steroid therapy should be monitored closely, and healthcare providers should consider the minimal effective dose to reduce adrenal gland suppression risks. This evidence advocates for increased awareness and careful management strategies to prevent adrenal insufficiency among chronic steroid users.