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 leukemia).[3][4] The prevalence or incidence of adrenal suppression in these different subpopulations is not often reported but may be more common than generally believed. 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 hematologic malignancies and systemic corticosteroids).[3] In one review of symptomatic adrenal suppression among children in Canada, the estimated annual incidence was 0.35 per 100,000 children ages 0-18 years.[2] The review acknowledged that incidence rates in at-risk groups, such as those treated with corticosteroids, would be much higher.[2] Almost 80% of the children with symptomatic adrenal suppression had received inhaled corticosteroid.[2] 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%.[5] In children receiving pharmacologic doses of glucocorticoids for inflammatory bowel disease, up to 20% exhibited prolonged adrenal suppression, even after a slow taper.[6]

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