SFEIES24 Poster Presentations Adrenal & Cardiovascular (40 abstracts)
Assessing the adverse health impacts of glucocorticoid therapy in obstructive lung disease (AHEIGHT Study)
Julie Martin-Grace 1 , Sarah Lawless 1 , Maria Tomkins 1,2 , Vincent Brennan 1 , Karen Heverin 1 , Shari Srinivasan 1 , Deirdre Long 1 , Richard Costello 1,2 , Michael W. O’Reilly 1,2 & Mark Sherlock 1,2
1Beaumont Hospital, Dublin, Ireland; 2Royal College of Surgeons in Ireland, Dublin, Ireland
Background: Oral and inhaled glucocorticoids are commonly used medications in the treatment of obstructive lung disease, and both are associated with glucocorticoid-induced adrenal insufficiency (GIAI) (1). However, the prevalence and clinical consequences of GIAI in this population are incompletely understood.
Aims/Methods: We aimed to assess the prevalence of undiagnosed GIAI in an unselected cohort of patients with asthma attending secondary care, and compare cardiometabolic risk profiles and health-related quality of life (HRQoL) in patients with and without GIAI. Forty-seven participants were recruited prospectively to attend a single study visit which included a short synacthen test (SST), assessment of glucocorticoid exposure over previous 12 months, body composition analysis, markers of metabolic health and HRQoL questionnaires.
Results: The prevalence of undiagnosed GIAI in our cohort was 38%(18/47). The risk of GIAI varied according to glucocorticoid exposure. Three-quarters of participants (12/16) on regular oral and inhaled glucocorticoids failed the SST, compared with 19% (6/31) of those on regular inhaled glucocorticoids and intermittent oral exposure only. There was no difference in markers of asthma control between those who passed or failed SST. Weight-adjusted cumulative prednisolone exposure was significantly higher in those with GIAI than those without, driven by maintenance prednisolone use (34 mg/kg vs. 6.5 mg/kg, P = 0.001). There was no significant difference in markers of cardiometabolic health between the two groups. While participants with GIAI reported HRQoL scores suggesting greater physical limitations and poorer physical function than those with intact adrenal function, when age, lung function and participant sex was accounted for, there was no clear association between HRQoL and baseline serum cortisol concentration.
Conclusion: Undiagnosed GIAI is very common in patients with asthma attending secondary care, but the risk varies according to pattern of glucocorticoid exposure. The full extent of the clinical implications of this diagnosis beyond adrenal crisis risk remain incompletely understood.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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