Glucocorticoids and Pituitary Adenomas

Relationship Between Glucocorticoids and the Pituitary

Exogenous glucocorticoid therapy can cause suppression of the hypothalamo-pituitary-adrenal axis, sometimes referred to as tertiary adrenal insufficiency, across all routes of administration, including oral, inhaled, topical, intranasal, and intra-articular, as reported by the Anaesthesia society 1, 2
This suppression can occur at commonly prescribed doses and in a dose-dependent manner, even with inhaled corticosteroids that were previously thought to be safe within recommended dose ranges, according to the Anaesthesia society 1
Seven in 1000 people are prescribed long-term oral corticosteroid therapy, creating a large population at risk of adrenal crisis due to HPA axis suppression, as noted by the Anaesthesia society 1

In Cushing's disease, ACTH-secreting pituitary adenomas cause hypercortisolism, as reported in Nature Reviews Endocrinology 3
Corticotroph adenomas are the most common pituitary adenoma diagnosed in early childhood, accounting for 55% of pituitary adenomas in those aged 0-11 years and 30% in those aged 12-17 years, according to Nature Reviews Endocrinology 3
Patients with secondary adrenal insufficiency due to pituitary disorders are deficient in cortisol but continue to secrete aldosterone in response to renin, as noted by the Anaesthesia society 1, 2

Patients taking physiological replacement doses of corticosteroids for either primary or secondary adrenal insufficiency are at significant risk of adrenal crisis and must be given stress doses of hydrocortisone during periods of physiological stress, such as surgery, as recommended by the Anaesthesia society 4
Daily doses of prednisolone of 5 mg or greater in adults and 10-15 mg/m² hydrocortisone equivalent or greater in children may result in HPA axis suppression if administered for 1 month or more, according to the Anaesthesia society 4
Documented side effects of steroid therapy include lipodystrophy, hypertension, cardiovascular disease, osteoporosis, impaired wound healing, myopathy, cataracts, peptic ulcers, infection, mood disorders, and diabetogenesis, as reported in the American Academy of Otolaryngology-Head and Neck Surgery 5
Clinicians should be aware that exogenous glucocorticoid therapy can mask symptoms of pituitary adenomas by suppressing the HPA axis, potentially delaying diagnosis, as noted by the Anaesthesia society 1, 2