How do corticosteroids cause adrenal insufficiency?

The article was professionally consulted with Master, Doctor Le Hong Duong - Anesthesiologist - Department of General Surgery & Anesthesia - Vinmec Hai Phong International General Hospital.

Corticosteroids have anti-inflammatory and immunosuppressive effects and are widely used in the treatment of autoimmune diseases. Abuse of corticosteroids due to the habit of self-purchase, self-administration and self-discontinuation of drugs can cause adrenal insufficiency.

The effects of drugs containing corticosteroids - steroid hormones are immunosuppressive, anti-inflammatory and are often used in the treatment of immune and allergic diseases such as rheumatoid arthritis, asthma, lupus erythematosus system red, ...
During the drug administration, depending on the dose used, the duration of treatment, the route of administration (oral, injection, inhalation, spray, topical, ...) the composition of the drug. (Corticosteroids are often synthesized with many other substances), the side effects caused by corticosteroids will be different.
Adrenal insufficiency is one of the common side effects caused by abrupt discontinuation of corticosteroids while using or abusing corticosteroids. This condition is common in women, between the ages of 25 and 40, due to the habit of self-medicating with corticosteroids but not using them properly.

In the body, the location of the adrenal glands is above the 2 kidneys. This is an endocrine gland consisting of a medulla on the inside and a cortex on the outside. The medulla is responsible for secreting hormones to maintain a normal heart rate and blood pressure. The cortex is responsible for secreting corticosteroid hormones to contribute to the body's metabolic control, immune function, and inflammation.

Abuse of corticosteroids will cause dysfunction and inhibit the activity of the adrenal glands. When stopping the drug suddenly, the adrenal gland cannot function normally, reducing its hormone secretion function, leading to an imbalance of metabolic processes in the body.

Adrenal insufficiency due to corticosteroid abuse has the following symptoms:
Fatigue, muscle weakness, loss of appetite, weight loss Diarrhea, abdominal pain, vomiting, nausea Fever, headache, low blood pressure, low blood sugar Mental disturbances, consciousness, possible coma, lethargy

Currently, to treat adrenal insufficiency caused by corticosteroid abuse, patients are prescribed to quit smoking and have blood tests to monitor cortisol levels. Withdrawal is aimed at avoiding functional adrenal insufficiency and other drug-induced side effects. There are 2 methods of corticoid withdrawal, that is:
Reduce the drug slowly in terms of time of use: The patient reduces the drug slowly, then, relaxes the time of taking the drug and stops using it completely. Before stopping completely, the patient needs blood tests to check cortisol levels and assess adrenal function.

Reduce drug slowly in dosage: The patient reduces the drug slowly, from high dose to physiological dose. When it comes to the physiological dosing phase, the patient should have blood tests to check for cortisol levels and assess for adrenal insufficiency. If the standard is reached, the drug can be stopped. In addition to adrenal insufficiency, corticosteroid abuse also causes a number of other side effects. Therefore, to prevent adrenal insufficiency, patients should not buy and use drugs without a doctor's prescription. If you have to take medicine, you should absolutely follow your doctor's instructions, avoid abuse or stop taking it suddenly.
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