title: Adrenal insufficiency in patients with stable non-cystic fibrosis bronchiectasis.
abstract: OBJECTIVE
  Suppressed adrenal responses associated with inhaled steroid use have been reported in patients with bronchiectasis and have been shown to be associated with poor quality of life. This study was undertaken to examine the prevalence of suppressed cortisol responses in stable bronchiectasis and determine their correlation with the use of inhaled corticosteroids, radiologic severity of bronchiectasis and quality of life (QOL) scores.
  
  
  METHODS
  In this case-control study, cases were patients with bronchiectasis and suppressed cortisol responses and controls were healthy volunteers, and patients with bronchiectasis without suppressed cortisol responses. Symptoms, lung function test values, exercise capacity, HRCT severity scores for bronchiectasis, exacerbations, inhaled corticosteroid use and quality of life scores were compared between patients with and without suppressed cortisol values.
  
  
  RESULTS
  Forty consecutive patients with bronchiectasis and 40 matched controls underwent 1-μg cosyntropin testing. Baseline cortisol (mean difference -2.0 μg/dl, P=0.04) and 30-minute stimulated cortisol (mean difference -3.73 μg/dl, P=0.001) were significantly lower in patients with bronchiectasis. One patient had absolute adrenal insufficiency and 39.5 per cent (15/38) patients with bronchiectasis had impaired stimulated responses. Baseline and stimulated cortisol responses were unaffected by inhaled steroids (O.R 1.03, P=0.96). SGRQ scores were negatively correlated with body mass (r= -0.51, P=0.001) and bronchiectasis severity (r=0.37, P=0.019), but not related to baseline or stimulated cortisol responses.
  
  
  CONCLUSIONS
  Our results showed that the impaired adrenal responses to 1-μg cosyntropin were common in patients with bronchiectasis. This was not associated with the use of inhaled steroids or severity of bronchiectasis. Poor health status was associated with advanced disease and not with cortisol responses to the 1-μg cosyntropin test.
authors.affiliation: Department of Pulmonary & Critical Care Medicine, St John's Medical College Hospital, Bangalore; Department of Pulmonary & Solid organ transplant ICU, Global Hospitals & Health City, Chennai, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Rajagopala
authors.forename: Anantharaman
authors.initials: A
authors.lastname: Ramakrishnan
authors.forename: Ganapathi
authors.initials: G
authors.lastname: Bantwal
authors.forename: Uma
authors.initials: U
authors.lastname: Devaraj
authors.forename: Smrita
authors.initials: S
authors.lastname: Swamy
authors.forename: S Vageesh
authors.initials: SV
authors.lastname: Ayyar
authors.forename: George
authors.initials: G
authors.lastname: D'Souza
mesh_terms: D000280:Administration, Inhalation; D000309:Adrenal Insufficiency / Q000209:etiology* / Q000473:pathology*; D001987:Bronchiectasis / Q000097:blood / Q000150:complications*; D003366:Cosyntropin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D005541:Forced Expiratory Volume; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007194:India; D007407:Interviews as Topic; D011788:Quality of Life; D012129:Respiratory Function Tests; D013147:Spirometry; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014797:Vital Capacity
chemical_list: D003366:Cosyntropin; D006854:Hydrocortisone