TOPLINE:

The long-term use of systemic corticosteroids was associated with a notably higher risk for adrenal insufficiency (AI) and related hospitalisation than the long-term use of non-steroidal anti-inflammatory drugs (NSAIDs). In contrast, the long-term use of inhaled corticosteroids was associated with a modestly increased risk for AI without a statistically significant rise in related hospitalisations.

METHODOLOGY:

• Researchers conducted a retrospective propensity score-matched cohort study using data from the TriNetX network to assess the risk for AI and related hospitalisation in patients receiving long‑term systemic or inhaled corticosteroids.
• A total of 243,430 patients on long-term systemic corticosteroids and 315,237 patients on long-term inhaled corticosteroids were compared with corresponding NSAID-treated control individuals after propensity score matching; long-term use was defined as more than 3 months of use or current use of systemic or inhaled corticosteroids.
• The mean age of the cohort was approximately 57 years, and the mean follow-up duration was 2.4 years for systemic corticosteroid users and 2.2 years for inhaled corticosteroid users.
• Incident AI diagnoses and AI‑related hospitalisations were ascertained from the first day after the index date (the first record of long‑term corticosteroid or NSAID use).

TAKEAWAY:

• After follow-up, patients who received long-term systemic corticosteroids had a higher risk for AI (hazard ratio [HR], 6.32; P < .0001) and related hospitalisation (HR, 3.52; P < .0001) than those who received long-term NSAIDs.
• Patients who received long-term inhaled corticosteroids had a modestly increased risk for AI compared with those who received long-term NSAIDs (HR, 1.55; P < .0001).
• The risk for AI-related hospitalisation did not differ significantly between long‑term inhaled corticosteroid users and long‑term NSAID users.

IN PRACTICE:

"[The study] findings highlight the importance of systematic clinical vigilance, structured patient education, and planned tapering strategies to prevent and mitigate corticosteroid-induced adrenal insufficiency," the authors wrote.

SOURCE:

This study was led by Patricia Vaduva, Department of Endocrinology, Diabetes, Nutrition, Rennes University Hospital, Rennes, France. It was published online on March 15, 2026, in the European Journal of Endocrinology.

LIMITATIONS:

The observational design of the study may have introduced residual confounding and restricted causal inference. The long-term use of corticosteroids was defined using administrative codes, which did not capture precise dosing, actual duration, or adherence. The true incidence of AI may have been underestimated because diagnosis relied on standard codes.

DISCLOSURES:

This study did not receive any funding from any sources. The authors declared having no conflicts of interest.

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