Association of subclinical hypothalamic-pituitary-adrenal axis suppression with bone loss in patients with asthma taking inhaled corticosteroids

Kasayama, Soji; Otsuki, Michio; Tanemura, Mari; Fujita, Kimie; Miyatake, Akihiko

doi:10.1016/j.anai.2013.07.001

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…Nasal steroid sprays are largely regarded as safe medications, with little effect on HPAA function 18–20 . Inhaled and oral corticosteroids, however, have known systemic side effects of adrenal suppression and may be associated with dose‐dependent hypocortisolemia 21–25 . Given the chronicity of CRS and the association of asthma as a common comorbidity, patients with CRS who begin BI de novo may already have subclinically diminished adrenal function related to prior cumulative exposures to inhaled and oral steroids.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20] Inhaled and oral corticosteroids, however, have known systemic side effects of adrenal suppression and may be associated with dose-dependent hypocortisolemia. [21][22][23][24][25] Given the chronicity of CRS and the association of asthma as a common comorbidity, patients with CRS who begin BI de novo may already have subclinically diminished adrenal function related to prior cumulative exposures to inhaled and oral steroids. Since we did not perform baseline stimulated cortisol testing prior to initiating BI therapy, we were unable to ascertain whether patients taking multiple forms of corticosteroids had preexisting adrenal suppression prior to initiating BI, nor did we have a comparison cohort of patients who were taking inhaled and oral steroids without BI.…”

Section: Discussionmentioning

confidence: 99%

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Incidence of hypocortisolism with long‐term budesonide irrigation for chronic rhinosinusitis

Silva

Tyler

et al. 2023

Int Forum Allergy Rhinol

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BackgroundBudesonide irrigations (BIs) are commonly used to control inflammation in chronic rhinosinusitis (CRS). In 2016 we reported an analysis of long‐term BI with regard to hypothalamic‐pituitary‐adrenal axis function. We present a follow‐up analysis in a larger cohort of patients with longer follow‐up.MethodsPatients were candidates for stimulated cortisol testing after regularly performing BI for CRS at least daily for ≥6 months. We retrospectively evaluated all patients who received stimulated cortisol testing at our center between 2012 and 2022. We correlated cortisol levels with the use of BI and other forms of corticosteroids.ResultsWe analyzed 401 cortisol test results in 285 patients. The mean duration of use was 34 months. Overall, 21.8% of patients were hypocortisolemic (<18 ug/dL) at first test. In patients who used only BI, the rate of hypocortisolemia was 7.5%, whereas in patients who also used concurrent oral and inhaled corticosteroids, the rate was 40% to 50%. Lower cortisol levels were associated with male sex (p < 0.0001) and concomitant use of oral and inhaled steroids (p < 0.0001). Duration of BI use was not significantly associated with lower cortisol levels (p = 0.701), nor was greater dosing frequency (p = 0.289).ConclusionProlonged use of BI alone is not likely to cause hypocortisolemia in the majority of patients. However, concomitant use of inhaled and oral steroids and male sex may be associated with hypocortisolemia. Surveillance of cortisol levels may be considered in vulnerable populations who use BI regularly, particularly in patients using other forms of corticosteroids with known systemic absorption.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence of hypocortisolism with long‐term budesonide irrigation for chronic rhinosinusitis

Silva

Tyler

et al. 2023

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

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Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis

Broersen

Pereira

Jørgensen

et al. 2015

The Journal of Clinical Endocrinology &Amp; Metabolism

341

307

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1) Adrenal insufficiency after discontinuation of glucocorticoid occurs frequently; 2) there is no administration form, dosing, treatment duration, or underlying disease for which adrenal insufficiency can be excluded with certainty, although higher dose and longer use give the highest risk; 3) the threshold to test corticosteroid users for adrenal insufficiency should be low in clinical practice, especially for those patients with nonspecific symptoms after cessation.

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Association of subclinical hypothalamic-pituitary-adrenal axis suppression with bone loss in patients with asthma taking inhaled corticosteroids

Cited by 2 publications

References 10 publications

Incidence of hypocortisolism with long‐term budesonide irrigation for chronic rhinosinusitis

Incidence of hypocortisolism with long‐term budesonide irrigation for chronic rhinosinusitis

Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis

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