Real word incidence of adrenal insufficiency after long-terme use os systemic and inhaled corticosteroids

Patricia Vaduva; Fabrice Bonnet; Gregoire Fauchier; Gerald Raverot; Jerome Bertherat; Laurent Fauchier

doi:10.1530/endoabs.110.P44

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Endocrine Abstracts (2025) 110 P44 | DOI: 10.1530/endoabs.110.P44

ECEESPE2025 Poster Presentations Adrenal and Cardiovascular Endocrinology (169 abstracts)

Real word incidence of adrenal insufficiency after long-terme use os systemic and inhaled corticosteroids

Patricia Vaduva ¹ , Fabrice Bonnet ¹ , Gregoire Fauchier ² , Gerald Raverot ³ , Jérôme Bertherat ⁴ & Laurent Fauchier ⁵

Author affiliations

¹Department of Endocrinology, Diabetes, Nutrition; Rennes University Hospital, Rennes, France; ²Department of Endocrinologi, Diabetes and Nutrition, Orleans University Hospital, Orleans, France; ³Department of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France; ⁴Department of Endocrinology, Cochin Hospital, APHP, Paris, France; ⁵Department of Cardiology, Tours University Hospital, Tours, France

JOINT2931

Aim: The incidence of adrenal insufficiency following chronic use of both systemic and inhaled corticosteroids remains poorly known. The aim of our study was to assess the incidence of hospitalization for adrenal insufficiency (AI) after long-term use of systemic and inhaled corticosteroids in a large population-based cohort.

Methods: We used TriNetx Research Collaborative network, with access to electronic medical records from a number of participating health care organizations, to identify participants. Diagnosis was done using the International Classification of Diseases codes, and data on medications were studied. We included individuals who were treated with long-term systemic or inhaled only corticosteroids. We excluded those with a past history of causes of primary and secondary adrenocortical insufficiency. We used a 1:1 propensity-score to compare matched subjects treated by long term systemic (n=243,430) or inhaled (n=315,237) steroid to subjects treated by NSAID only.

Results: Mean age of the population studied was 56.5±18 years, with 40% of men. Over a mean follow-up of 2.4±1.9 years, long-term systemic corticosteroids use was associated with a more frequent diagnosis of AI (0.20% vs 0.04% per year; HR: 6.32, 95%CI [5.50–7.26], P<0.001) and a greater incidence of hospitalization for AI (0.02% vs 0.008% per year; HR: 3.52, 95%CI [2.57–4.84], P<0.001) as compared to individuals treated with NSAID. Long-term inhaled corticosteroids use was associated with a more common diagnosis of AI (0.05% vs 0.04% per year; HR: 1.55, 95%CI [1.34–1.80], P<0.001), without increased risk of hospitalization for AI (0.01% vs 0.01% per year; HR: 1.26, 95%CI [0.91–1.76], P=0.17) as compared to NSAID therapy.

Conclusions: Long-term use of systemic corticosteroids was associated with an increased risk of diagnosed AI with a greater incidence of hospitalization for AI over a 2.4-year follow-up. Inhaled corticosteroids use was associated with an increased incidence of diagnosed AI. These findings from a large real world-based cohort underscore the importance of preventing the onset of corticotropic insufficiency among individuals with long-term corticosteroids treatment.