Inhaled Corticosteroids and Adrenal Insufficiency

Molimard, Mathiéu; Girodet, Pierre‐Olivier; Pollet, Clothilde; Fourrier‐Réglat, Annie; Daveluy, Amélie; Haramburu, Françoise; Fayon, Michaël; Tabarin, Antoine

doi:10.2165/00002018-200831090-00005

Cited by 60 publications

(39 citation statements)

References 18 publications

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“…This may be linked to differences in the active substances and/or pharmacodynamic properties related to administration mode; oral administration being generally associated with slower absorption/distribution, higher metabolism due to hepatic first-pass effect, and lower biologically active circulating metabolites. Adrenal insufficiency and Cushing's syndrome have also been reported in patients treated with inhaled CS (Molimard et al, 2008). In our study, however, the small number of subjects taking CS using either mode did not allow us to examine the effect of administration method.…”

Section: Cs Use and Cognitive Declinementioning

confidence: 65%

Steroid and nonsteroidal anti-inflammatory drugs, cognitive decline, and dementia

Ancelin

Carrière

Helmer

et al. 2012

Neurobiology of Aging

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Section: Cs Use and Cognitive Declinementioning

confidence: 65%

Steroid and nonsteroidal anti-inflammatory drugs, cognitive decline, and dementia

Ancelin

Carrière

Helmer

et al. 2012

Neurobiology of Aging

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“…Dinsen et al [4] reviewed this topic and concluded that oral glucocorticoids could induce adrenocortical insufficiency in up to 46-100% of patients. Even inhaled glucocorticoid treatment can lead to adrenocortical insufficiency [14,15,16]. Only few results of adrenocortical function in relation to intermittent glucocorticoid pulse therapy have been reported [17,18,19].…”

Section: Discussionmentioning

confidence: 99%

Methylprednisolone Pulse Treatment of Graves' Ophthalmopathy Is Not Associated with Secondary Adrenocortical Insufficiency

2015

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Objective: Graves' ophthalmopathy (GO) is an inflammatory disease in the orbital region. The first-line medical treatment is glucocorticoids. An important potential side effect of glucocorticoid treatment is suppression of the hypothalamic-pituitary-adrenal (HPA) axis with impairment of endogenous cortisol production, implicating symptoms of adrenocortical insufficiency, especially in the period after cessation of therapy with possible risks in cases of intercurrent illness. The aim of this study was to evaluate HPA axis function before and after methylprednisolone pulse treatment of GO. Study Design: HPA axis function was evaluated by measurements of plasma ACTH and an ACTH stimulation test with plasma cortisol measurements at 0 and 30 min after an intravenous bolus of synthetic ACTH (Synacthen® 250 µg). This was done in 12 patients with GO before and at cessation of methylprednisolone pulse treatment (500 mg i.v. per week for 6 weeks followed by 250 mg i.v. per week for an additional 6 weeks). Results: All patients included fulfilled the criteria of intact HPA axis function before and at cessation of methylprednisolone pulse treatment. Data are given as medians (with ranges). Before glucocorticoid treatment basal plasma cortisol was 290 nM (196-579) and 786 nM (612-1,050) after ACTH stimulation. At cessation of therapy the corresponding values were 309 nM (88-718) and 852 nM (524-1,011), respectively. Thus, all patients passed a 30-min stimulated plasma cortisol of 500 nM. Before treatment plasma ACTH was 4.2 pmol/l (4-16) and at cessation of therapy the corresponding value was 4.8 pmol/l (2-9; p = 0.27). Conclusion: Transient suppression of the HPA axis with secondary adrenocortical insufficiency does not seem to be a common phenomenon after intravenous methylprednisolone pulse therapy for GO. Therefore, routine precautions are not necessary. However, our results do not exclude that transient secondary adrenocortical insufficiency might occur occasionally.

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“…Potential systemic side effects of ICSs include suppression of the hypothalamus-pituitaryadrenal (HPA) axis, Cushing syndrome, osteoporosis, cataracts, dermal thinning and bruising, adrenal insufficiency, and growth suppression in children (4,5). Cushing syndrome and associated adrenal insufficiency have been reported with high doses of ICSs or as a result of drug interaction with CYP3A4 inhibitors (64,65). Additionally, ICS therapy increases the risk of pneumonia in patients with COPD (6,55).…”

Section: Adverse Effectsmentioning

confidence: 99%

“…They are all extensively metabolized by intestinal and hepatic CYP 3A4, which affects their systemic availability and clearance. Adrenal suppression, Cushing syndrome, and death have been reported with coadministration of these agents (64,74).…”

Section: Drug Interactionsmentioning

confidence: 99%