Risk of hospitalization for adrenal insufficiency following long-term systemic and inhaled corticosteroid use: a comparative TriNetX network analysis

OBJECTIVE: Limited data exist regarding the incidence of glucocorticoid-induced adrenal insufficiency (AI). The incidence of hospitalization for AI remains poorly characterized. In a retrospective propensity score-matched cohort study, we assessed the incidence of AI and hospitalization for AI in patients receiving long-term systemic or inhaled corticosteroids compared with those receiving nonsteroidal anti-inflammatory drugs (NSAIDs). DESIGN/METHODS: Participants were recruited from the TriNetX Research Collaborative network. Using propensity score matching (1:1), we compared adults receiving long-term (>3 months) systemic or inhaled corticosteroids with those treated with NSAIDs. We assessed the rates of AI diagnosis and hospitalization for AI in the two groups. RESULTS: After matching, 243 430 patients on systemic corticosteroids and 315 237 patients on inhaled corticosteroids were compared with corresponding NSAID-treated controls. Mean age was 56.5 ± 18 years. Over a mean follow-up of 2.4 ± 1.9 years, long-term systemic corticosteroid use was associated with higher rates of AI diagnosis (0.20% vs 0.04% per year; HR 6.32, 95% CI 5.50-7.26, P < .001) and hospitalization for AI (0.02% vs 0.008% per year; HR 3.52, 95% CI 2.57-4.84, P < .001). Inhaled corticosteroid use was associated with increased AI diagnosis (0.05% vs 0.04% per year; HR 1.55, 95% CI 1.34-1.80, P < .001) but not with hospitalization for AI (HR 1.26, 95% CI 0.91-1.76, P = .17). CONCLUSIONS: Long-term systemic corticosteroid use substantially increases the risk of both AI diagnosis and hospitalization for AI. Inhaled corticosteroids confer a modest increase in AI diagnosis without significantly elevating hospitalization risk.