title: Adrenal Insufficiency in Corticosteroids Use: Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  We aimed to estimate pooled percentages of patients with adrenal insufficiency after treatment with corticosteroids for various conditions in a meta-analysis. Secondly, we aimed to stratify the results by route of administration, disease, treatment dose, and duration.
  
  
  METHODS
  We searched seven electronic databases (PubMed, MEDLINE, EMBASE, COCHRANE, CENTRAL, Web of Science, and CINAHL/Academic Search Premier) in February 2014 to identify potentially relevant studies. Original articles testing adult corticosteroid users for adrenal insufficiency were eligible.
  
  
  RESULTS
  We included 74 articles with a total of 3753 participants. Stratified by administration form, percentages of patients with adrenal insufficiency ranged from 4.2% for nasal administration (95% confidence interval [CI], 0.5-28.9) to 52.2% for intra-articular administration (95% CI, 40.5-63.6). Stratified by disease, percentages ranged from 6.8% for asthma with inhalation corticosteroids only (95% CI, 3.8-12.0) to 60.0% for hematological malignancies (95% CI, 38.0-78.6). The risk also varied according to dose from 2.4% (95% CI, 0.6-9.3) (low dose) to 21.5% (95% CI, 12.0-35.5) (high dose), and according to treatment duration from 1.4% (95% CI, 0.3-7.4) (<28 d) to 27.4% (95% CI, 17.7-39.8) (>1 year) in asthma patients.
  
  
  CONCLUSIONS
  1) Adrenal insufficiency after discontinuation of glucocorticoid occurs frequently; 2) there is no administration form, dosing, treatment duration, or underlying disease for which adrenal insufficiency can be excluded with certainty, although higher dose and longer use give the highest risk; 3) the threshold to test corticosteroid users for adrenal insufficiency should be low in clinical practice, especially for those patients with nonspecific symptoms after cessation.
authors.affiliation: Department of Clinical Epidemiology (L.H.A.B., O.M.D.), Leiden University Medical Centre, Leiden 2300RC, The Netherlands; Department of Medicine (L.H.A.B., A.M.P., O.M.D.), Division of Endocrinology, Leiden University Medical Centre, Leiden 2300RC, The Netherlands; Department of Endocrinology (J.O.L.J., O.M.D.), Aarhus University, 8000 Aarhus C, Denmark; and Department of Clinical Epidemiology (O.M.D.), Aarhus University, 8000 Aarhus C, Denmark.
authors.forename: Leonie H A
authors.initials: LH
authors.lastname: Broersen
authors.affiliation: Department of Clinical Epidemiology (L.H.A.B., O.M.D.), Leiden University Medical Centre, Leiden 2300RC, The Netherlands; Department of Medicine (L.H.A.B., A.M.P., O.M.D.), Division of Endocrinology, Leiden University Medical Centre, Leiden 2300RC, The Netherlands; Department of Endocrinology (J.O.L.J., O.M.D.), Aarhus University, 8000 Aarhus C, Denmark; and Department of Clinical Epidemiology (O.M.D.), Aarhus University, 8000 Aarhus C, Denmark.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
authors.affiliation: Department of Clinical Epidemiology (L.H.A.B., O.M.D.), Leiden University Medical Centre, Leiden 2300RC, The Netherlands; Department of Medicine (L.H.A.B., A.M.P., O.M.D.), Division of Endocrinology, Leiden University Medical Centre, Leiden 2300RC, The Netherlands; Department of Endocrinology (J.O.L.J., O.M.D.), Aarhus University, 8000 Aarhus C, Denmark; and Department of Clinical Epidemiology (O.M.D.), Aarhus University, 8000 Aarhus C, Denmark.
authors.forename: Jens Otto L
authors.initials: JO
authors.lastname: Jørgensen
authors.affiliation: Department of Clinical Epidemiology (L.H.A.B., O.M.D.), Leiden University Medical Centre, Leiden 2300RC, The Netherlands; Department of Medicine (L.H.A.B., A.M.P., O.M.D.), Division of Endocrinology, Leiden University Medical Centre, Leiden 2300RC, The Netherlands; Department of Endocrinology (J.O.L.J., O.M.D.), Aarhus University, 8000 Aarhus C, Denmark; and Department of Clinical Epidemiology (O.M.D.), Aarhus University, 8000 Aarhus C, Denmark.
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Dekkers
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000453:epidemiology*; D000328:Adult; D004304:Dosage Forms; D004305:Dose-Response Relationship, Drug; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D006801:Humans; D007249:Inflammation / Q000188:drug therapy / Q000453:epidemiology; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology; D016377:Organ Transplantation / Q000379:methods / Q000706:statistics & numerical data; D012871:Skin Diseases / Q000188:drug therapy / Q000453:epidemiology; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000706:statistics & numerical data
chemical_list: D000305:Adrenal Cortex Hormones; D004304:Dosage Forms