Epidemiology

Adrenal suppression is most commonly encountered in patient populations where an underlying disease is treated with exogenous glucocorticoids (e.g., chronic obstructive pulmonary disease, asthma, arthritis, or certain malignancies such as leukaemia).[3][4]

The percentage of patients who develop adrenal insufficiency after the use of corticosteroids varies with the mode of delivery and underlying disease (e.g., 6.8% of asthma patients with inhaled corticosteroids only; 60% of patients with haematological malignancies and systemic corticosteroids).[3] Systematic reviews and meta-analysis report corticosteroid-induced adrenal insufficiency in 38% to 49% of adults during, or immediately following, systemic corticosteroid therapy.[3][5]

In one study of children taking medium doses, or less, of inhaled corticosteroids for the treatment of asthma, the prevalence of hypothalamic-pituitary-adrenal axis suppression was 9.3%.[6] In children receiving pharmacological doses of glucocorticoids for inflammatory bowel disease, up to 20% exhibited prolonged adrenal suppression, even after a slow taper.[7]

Using a national surveillance network (Canadian Paediatric Surveillance Program), the minimal incidence of symptomatic adrenal suppression in the paediatric population of Canada was estimated to be 0.35 per 100,000.[2] The symptomatic adrenal suppression incidence rate would be considerably higher if the at-risk paediatric population (i.e., those treated with systemic corticosteroids) was included.[2]

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