Adrenal insufficiency

Description: adrenal insufficiency (or “weakness” of the adrenal glands) occurs only when the steroid treatment stops or is abruptly terminated (generally, when the dose falls below 5 mg per day). This is a very rare complication. The symptoms include unusual fatigue, abdominal pain, weight loss and sometimes fever.

Frequency: once long-term (over several weeks) cortisone treatment is stopped, the adrenal gland can become “lazy”. However, this effect does not severely affect the individual in the majority of cases. After a short while, the adrenal glands recover their initial functionality. The precise frequency of symptomatic adrenal insufficiency is poorly understood but appears to affect up to 1% of patients who received corticosteroids for many months.

Subjects at risk: only patients treated with tablets or injections over several weeks at doses above 10-15 mg per day are at risk for adrenal insufficiency. Some corticosteroids (e.g., prednisone or prednisolone) were observed to carry less risk than others (e.g., betamethasone).

Long versus short-term treatment: a risk exists after corticosteroids are stopped after several weeks or months of exposure. If the maximum dose given is no more than 5 or 10 mg per day the risk of adrenal insufficiency is very low. This risk is only present when treatment is stopped or sharply reduced.

Prevention/treatment: a gradual reduction in cortisone towards the end of a long-term treatment can help limit the risk of adrenal insufficiency. However, when it occurs, this condition can be treated fairly easily with hydrocortisone for a few weeks/months.

Screening: when necessary, a simple biological screening (test with Synacthen®) may be prescribed.

Reversibility: it is completely reversible over a few weeks/months.

Useful references
  • Goichot B et al. Que reste t-il de l’insuffisance surrénale post-corticothérapie. Presse Med. 2007
  • Mortimer KJ et al. Oral and inhaled corticosteroids and adrenal insufficiency: a case-control study. Thorax. 2006