Introduction
Adrenal insufficiency (AI) secondary to long-term oral corticosteroids (OCS) ? both daily maintenance (mOCS) and short burst (sbOCS) ? is an under-recognised complication of severe asthma treatment (Gurnell, M. et al. J Int Med. 2021;290(2):240-256). We describe outcomes of short synacthen testing (SST) for iatrogenic AI over 3 years in our severe asthma service.
Methods
We reviewed patients who underwent SST from 01/04/19?01/04/22. Patients with AI were compared to those without, assessing for predictive factors. Data were collected on outcome following SST.
Results
89 patients (72 on biologics) with history of mOCS and/or recurrent sbOCS use underwent SST; 38 had confirmed AI. Patients with AI had a higher mOCS dose than those without (5.88 v 4.01 mg/day, p=0.002). Other physiological factors were not significantly different. Equal numbers of patients with and without AI reported AI-related symptoms prior to SST.
| No AI (n=51) | AI (n=38) | p-value | |
| FEV1 (Mean±SD) | 1.9±0.8 | 1.96±0.68 | 0.26 |
| ACQ-6 (Mean±SD) | 3.1±1.4 | 2.99±1.67 | 0.72 |
| mOCS at SST (Mean±SD) | 4.0±2.5 | 5.88±2.91 | 0.002 |
| Yearly sbOCS (Mean±SD) | 3.7±3.0 | 3.8±3.0 | 0.34 |
| Months on biologics (Mean±SD) | 11.7±10.2 | 14.6±20.9 | 0.44 |
| AI symptoms (Y/N) | 16/35 | 16/22 | 0.30 |
Following SST, 21/38 patients with AI were switched to hydrocortisone therapy, while 17 remained on mOCS. 25/51 patients without AI were weaned off mOCS, while 15/51 had an ongoing mOCS wean at time of writing.
Conclusion
Over 40% of our cohort had AI diagnosed after SST. Higher daily mOCS dose appears to increase risk but symptoms of AI, or absence thereof, were not predictive of AI; systematic screening for all patients with OCS exposure sufficient for biologics is prudent.