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HomeEndocrinologySteroids: 'Substantial' risk of adrenal malfunction

Steroids: 'Substantial' risk of adrenal malfunction

After stopping steroids commonly prescribed for asthma and allergies, a significant number of people may experience signs of malfunctioning in the adrenal glands, a European study finds. So-called adrenal insufficiency can be dangerous, especially if the person's body has to cope with a stress like surgery, injury or a serious illness, the study authors say in a Reuters Health report .

"The takeaway message of the study is that in corticosteroid use there is a substantial risk of adrenal insufficiency," senior author Dr Olaf Dekkers, an endocrinologist at Aarhus University in Denmark. "Patients should be aware of this risk and be informed about potential symptoms." Those symptoms can include fatigue, dizziness, weight loss and salt cravings, the authors say.

Corticosteroids are man-made drugs designed to mimic the hormone cortisol, which the adrenal glands produce naturally. The drugs are usually used to counter inflammation in a wide range of conditions, including asthma, psoriasis, rheumatoid arthritis, lupus, blood cancers and organ transplants.

People with adrenal insufficiency do not make enough of two hormones, cortisol and aldosterone. Cortisol helps the body respond to stress, recover from infections and regulate blood pressure and metabolism. Aldosterone helps maintain the right amounts of salt, potassium and water in the body.

While on steroids, the body often produces less of these hormones naturally, and after coming off the drugs it can take a while for natural production to ramp back up. The result is adrenal insufficiency, which can be treated with medication to replace cortisol or aldosterone.

Dekkers and colleagues analysed 74 research articles published from 1975 to 2014, covering a total of 3,753 study participants, to see how different doses and types of corticosteroid treatment might impact the likelihood of developing adrenal insufficiency after treatment.

Researchers found the risk of adrenal insufficiency was highest when corticosteroids were taken orally or injected, and lower with inhaled, nasal or topical treatment. When they looked just at patients using steroids for asthma, the researchers found that the risk of adrenal insufficiency was about 7% with inhaled corticosteroids, but about 44% with other formulations including oral medication. Only about 2% of asthma patients on the lowest dose of steroids experienced adrenal insufficiency, compared with about 22% on the highest doses.

Similarly, slightly more than 1% of asthma patients on short-term steroids developed adrenal insufficiency, compared with about 27% on long-term treatment.

[link url="http://www.reuters.com/article/2015/04/23/us-health-steroids-adrenal-glands-idUSKBN0NE28S20150423"]Full Reuters Health report[/link]
[link url="http://press.endocrine.org/doi/abs/10.1210/jc.2015-1218"]Journal of Clinical Endocrinology and Metabolism,[/link]

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