Endocrine Abstracts

Introduction: Adrenal insufficiency (AI) is a recognised complication of prolonged corticosteroid use in severe asthma, where multi-route exposure is common. Although guidelines recommend precautions for high-dose inhaled corticosteroid (ICS) use, it’s unclear if ICS dose alone predicts AI. This study examined patients to assess the role of cumulative steroid exposure and evaluate the predictive value of ICS dose for adrenal suppression

Method: A retrospective review was conducted on patients seen at a Severe Asthma Clinic (March 2023–March 2024). Data included demographics, inhalers, cortisol levels, BMI and HbA1c. Possible AI was defined as morning cortisol <133nmol/l or afternoon <100nmol/l.

Results: 156 patients (63% female, mean age 52±16.5 years, 88% Caucasian) were reviewed. Comorbidities included diabetes (11) and hypertension (21). 51 patients had low random cortisol levels, indicating possible AI, while 105 patients showed no AI.

Conclusion: Similar rates of high-dose ICS use across both groups suggest that ICS dose alone may not reliably predict possible adrenal suppression. In contrast, greater systemic/cumulative steroid exposure, including nasal steroids and indicators of more complex disease were more strongly associated with possible AI. Increased steroid burden also correlated with higher mean BMI and HbA1c. These findings support the need for broader risk assessment strategies beyond ICS dosing and underscore the value of multidisciplinary evaluation.