Risk of hospitalization for adrenal insufficiency following long-term systemic and inhaled corticosteroid use: a comparative TriNetX network analysis
Authors' conclusion
Long-term systemic corticosteroid use substantially increases the risk of both AI diagnosis and hospitalization for AI. Inhaled corticosteroids confer a modest increase in AI diagnosis without significantly elevating hospitalization risk.
Study context
- Population
- Adults in the TriNetX Research Collaborative network; mean age 56.5 ± 18 yearsmatched cohorts
- Exposure
- Long-term systemic or inhaled corticosteroids vs nonsteroidal anti-inflammatory drugs (NSAIDs)
- Systemic corticosteroidsn = 243,430
- Inhaled corticosteroidsn = 315,237
- Outcome
- Rates of adrenal insufficiency (AI) diagnosis and hospitalization for AI
- Follow-up
- Mean 2.4 ± 1.9 years
Methodological detailspropensity score-matched (1:1), TriNetX Research Collaborative network
- Propensity score-matched (1:1)
- TriNetX Research Collaborative network
Main finding
As reported in the abstract
Each group vs NSAIDsHazard ratio (95% CI)P value
Systemic corticosteroidsAI diagnosis: 0.20%vs 0.04% per year
6.32(5.50–7.26)
P < 0.001Systemic corticosteroidsHospitalization for AI: 0.02%vs 0.008% per year
3.52(2.57–4.84)
P < 0.001Inhaled corticosteroidsAI diagnosis: 0.05%vs 0.04% per year
1.55(1.34–1.80)
P < 0.001Inhaled corticosteroidsHospitalization for AI
1.26(0.91–1.76)
P = 0.17Observational data: associations, not effects.
Original publication
Risk of hospitalization for adrenal insufficiency following long-term systemic and inhaled corticosteroid use: a comparative TriNetX network analysis. Eur J Endocrinol. Published 15 March 2026. doi:10.
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