TOPLINE:

In patients with adrenal insufficiency on glucocorticoid replacement therapy, the presence of leukocytosis was associated with metabolic complications and reduced muscle strength, potentially serving as a marker of supraphysiologic glucocorticoid dosing and prompting the need for glucocorticoid dose adjustment.

METHODOLOGY:

• Chronic supraphysiologic glucocorticoid exposure in adrenal insufficiency can cause metabolic complications, muscle weakness, and sarcopenia, yet no reliable laboratory biomarker exists to detect glucocorticoid overexposure.
• Researchers conducted a cross-sectional analysis to examine the association between metabolic complications and hematologic parameters, including leukocytosis and neutrophilia, and evaluated these parameters as potential markers of supraphysiologic glucocorticoid exposure.
• They included 98 patients with primary or secondary adrenal insufficiency (median age, 41.5 years; 49% women) receiving physiologic glucocorticoid replacement therapy.
• Patients were evaluated for BMI, waist and hip circumference, handgrip strength, muscle mass, gait speed, and quality of life.
• Hemogram parameters were recorded, with leukocytosis defined as having a leukocyte count of at least 11,000/µL and neutrophilia defined as having a neutrophil count of at least 7700/µL; information on comorbidities such as diabetes, hypertension, and dyslipidemia was retrieved from medical records.

TAKEAWAY:

• Overall, 17 patients had leukocytosis, and 10 had neutrophilia; hypertension, dyslipidemia, and metabolic syndrome occurred more frequently in those with leukocytosis, whereas BMI was higher and dyslipidemia was more common in those with neutrophilia than in those without (P ≤ .05 for all).
• Patients with vs without leukocytosis had lower handgrip strength (median, 23.6 vs 31.4 kg, P = .003) and reduced BMI-adjusted skeletal mass (P = .012); a higher proportion of patients with leukocytosis exhibited a gait speed < 0.8 m/s (P = .015).
• A leukocyte count exceeding 8550/mm³ predicted reduced handgrip strength, with 62.5% sensitivity and 58.1% specificity (area under the curve, 0.669; P = .013).
• Presence of leukocytosis, older age, and reduced quality of life were independently associated with having at least two comorbidities. Leukocyte count also correlated positively with BMI, waist and hip circumference, and A1c and triglyceride levels.

IN PRACTICE:

“These findings suggest that leukocytosis and neutrophilia may be useful clinical indicators of excessive GC [glucocorticoid] exposure, even when doses are considered physiologic,” the authors wrote.

SOURCE:

The study was led by Ummu Mutlu, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul University, Turkey. It was published online in Journal of Endocrinological Investigation.

LIMITATIONS:

The study excluded data on infections and inflammation, potentially overlooking occult conditions and other inflammatory diseases. The study relied on patient-reported data for glucocorticoid replacement dose and duration; any misreporting might have influenced the study results. The absence of a control group limited direct comparisons.

DISCLOSURES:

The study was supported by the Istanbul University Scientific Research Projects Coordination Unit. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.