Oral and inhaled corticosteroids and adrenal insufficiency: a case-control study

Kevin Mortimer ^1*, Laila J Tata ¹, Chris J P Smith ¹, Joe West ¹, Tim W Harrison ¹, Anne Tattersfield ¹ and Richard Hubbard ¹

¹ University of Nottingham, United Kingdom

^* To whom correspondence should be addressed. E-mail: kevinmortimer{at}msn.com.

Accepted 26 January 2006

Abstract

Background: Adrenal insufficiency, a well-recognised complication of treatment with oral corticosteroids, has been described in association with inhaled corticosteroid use in over 60 case reports. The risk of adrenal insufficiency in people prescribed an oral or inhaled corticosteroid in the general population is not known. Objective. To quantify the association between adrenal insufficiency and oral and inhaled corticosteroid exposure.

Methods: Case-control study using computerized general practice data from The Health Improvement Network.

Results: We identified 154 cases of adrenal insufficiency and 870 controls from a cohort of 2.4 million people. There was a dose-related increased risk of adrenal insufficiency in people prescribed an oral corticosteroid with an odds ratio of 2.0 (95% CI 1.6 to 2.5) per course of treatment per year. Adrenal insufficiency was associated with a prescription for an inhaled corticosteroid within the 90 days prior to the diagnosis with an odds ratio of 3.4 (95% CI 1.9 to 5.9) and this effect was dose-related (p for trend <0.001). After adjusting for oral corticosteroid exposure this odds ratio was reduced to 1.6 (95% CI 0.8 to 3.2) although the dose relation remained (p for trend 0.036).

Conclusion: People prescribed an oral or inhaled corticosteroid are at a dose-related increased risk of adrenal insufficiency although the absolute risk is small. Our analysis suggests that the increased risk in people prescribed an inhaled corticosteroid is largely due to oral corticosteroid exposure but there may be an effect of inhaled corticosteroids when they are taken at higher doses.

Keywords: adrenal insufficiency, inhaled corticosteroid

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