The Clinical Impact of Corticosteroid Supplementation in Febrile Patients with Adrenal Insufficiency

Corticosteroids are frequently administered to febrile patients with adrenal insufficiency to improve their clinical course. However, the effect of corticosteroid supplementation in these patients remains uncertain. This study evaluates the effect of corticosteroid supplementation on the clinical outcomes of these patients.

This retrospective study was conducted at a tertiary hospital with 855 beds in South Korea. Adult inpatients (≥19 years) who had undergone an adrenocorticotropic hormone (ACTH) stimulation test to identify the cause of fever (≥37.8℃) between 1 July 2019, and 30 June 2022 were included. The included patients were categorized based on corticosteroid supplementation until discharge. Clinical outcomes between the two groups were compared, and logistic regression analysis identified factors associated with prolonged hospitalization.

Of 216 patients, 74 (34.3%) received systemic corticosteroid supplementation. The median length of hospital stay after the ACTH stimulation test did not differ significantly between the two groups (7 days vs. 11.5 days, p=0.109). In the multivariate logistic regression analysis, female patients exhibited shorter hospitalization. Patients with the following features-a history of infectious disease within 1 month, confusion, a potassium level <3.8 mEq/L, and a hemoglobin level <10.0 g/dL at the time of diagnosis-tended to have longer hospital stays. However, corticosteroid supplementation was not a significant risk factor for prolonged hospitalization.

Administering corticosteroids to febrile patients with adrenal insufficiency did not show a significant impact on clinical outcomes and should be considered only after careful assessment in the clinical context.