Story at-a-glance
- Corticosteroids shut down natural cortisol production; even short-term use as brief as 14 days suppresses adrenal function, creating dangerous dependency on synthetic hormones
- A European study reveals widespread risk; over 500,000 patients showed six times higher adrenal insufficiency rates with oral steroids; even “safe” inhaled versions increased risk by 55%
- Sudden steroid withdrawal triggers emergency situations requiring immediate medical care due to collapsed fluid and electrolyte balance
- Nearly half (48.7%) of oral steroid patients develop adrenal suppression, yet most aren’t warned about or tested for this serious condition
- Recovery requires metabolic repair; focus on reducing inflammation, fixing insulin resistance, optimizing sleep cycles and supporting natural cortisol rhythms rather than more medications
A single prescription could silently sabotage your adrenal health. That’s the warning echoed by a growing body of evidence pointing to a serious risk: adrenal insufficiency triggered by common corticosteroid medications.
Whether you take steroids for asthma, arthritis, eczema or autoimmune conditions, the underlying mechanism is the same. Corticosteroids mimic cortisol — your body’s primary stress hormone. When synthetic steroids flood your system, your brain slows or shuts down natural cortisol production. If the drug is reduced too quickly or the medication is stopped altogether, your body is then left without the cortisol it needs to keep vital systems stable.
Unlike adrenal fatigue, which has no clinical test or consistent definition, adrenal insufficiency is a well-documented, often life-threatening condition. The symptoms start subtly — dizziness, nausea, exhaustion, low blood pressure — but escalate into adrenal crisis, a sudden collapse in fluid and electrolyte balance that requires immediate emergency care.
What makes this issue even more urgent is that it doesn’t take years of steroid use to put your adrenal system at risk. Short-term use, even as brief as a few months, has been linked to significant hormonal suppression. And it’s not just oral steroids. New data show that inhaled versions, once considered relatively safe, also carry measurable risk.1
Most people aren’t warned. Many are never tested. And yet the long-term consequences of undiagnosed adrenal insufficiency include increased hospitalizations, greater reliance on emergency care, and, in some cases, permanent hormone replacement. To understand the true scope of this risk, let’s turn to a major European investigation that tracked outcomes across more than half a million steroid users.
Even Low Doses of Steroids Shut Down Your Natural Cortisol
According to research presented at the 2025 Joint Congress of the European Society of Paediatric Endocrinology and the European Society of Endocrinology, researchers led by Dr. Patricia Vaduva from Rennes University Hospital in France analyzed medical records from over 500,000 people who had been prescribed corticosteroids, either as tablets or inhaled forms, for anywhere between three months and five years.2
• The longer you use steroids, the greater your risk of adrenal failure — The researchers found that patients who took steroid tablets for longer than three months were more than six times more likely to be diagnosed with adrenal insufficiency compared to those who used non-steroidal anti-inflammatory drugs (NSAIDs) instead.
These same patients also had more than triple the risk of hospitalization due to an adrenal crisis, a life-threatening event where your body can’t produce enough cortisol to handle stress or illness.
• Inhaled steroids were not as safe as most doctors think — Even among people using inhaled corticosteroids — often considered a low-risk option — there was a 55% increase in risk of adrenal insufficiency. Although this group didn’t show as many hospitalizations, the biological signs of suppressed adrenal function were still significant.
• The study revealed that adrenal suppression is cumulative and subtle — Over time, the body’s natural stress response becomes so blunted by external steroids that it’s no longer able to mount a healthy cortisol spike when needed. This doesn’t just increase the risk of adrenal crises. It also creates chronic issues with fatigue, poor stress tolerance and inflammation that worsens over time.
• The most dangerous outcomes came after sudden withdrawal — Patients who stopped steroids abruptly after long-term use were most likely to enter adrenal crisis. That’s because the adrenal glands don’t instantly resume function when steroid input stops. They remain “asleep” until your brain’s hypothalamus and pituitary glands start signaling for natural cortisol again — a process that takes time and isn’t guaranteed to succeed in everyone.
• Researchers stressed that even low-dose steroid use needs supervision — “Even low doses of inhaled corticosteroids, once considered relatively benign regarding systemic effects, have demonstrable potential to induce adrenal insufficiency,” Vaduva said.3 This contradicts longstanding beliefs in respiratory medicine and raises new concerns about how these drugs are prescribed and monitored.
Steroids Turn Off Your Adrenal Glands Through Feedback Signaling
Steroids mimic cortisol in your bloodstream. When your brain detects high cortisol levels, it sends a signal to stop producing adrenocorticotropic hormone (ACTH), the hormone that tells your adrenal glands to make cortisol. Without ACTH, your adrenal glands shrink and stop functioning. Over time, this creates total dependency on external steroid medication.
• The study calls for major changes in how steroids are prescribed — These findings suggest clinicians need to re-evaluate their use of long-term steroids, even in inhaled form. The researchers emphasized tapering off slowly instead of stopping suddenly and recommended hormone replacement like hydrocortisone during and after withdrawal to help prevent adrenal crises.4
• Monitoring cortisol levels makes sense even for inhaled forms — Because suppression occurs without symptoms, the study urges more frequent lab monitoring for people using any form of corticosteroids long-term. That includes people with asthma or allergies using inhalers, who unknowingly face the same hormonal suppression risks as those on oral tablets.
Adrenal Suppression Often Goes Undetected Without Proactive Screening
A comprehensive literature review published in Cureus found that patients taking oral glucocorticoids for extended periods are at significant risk of developing adrenal problems because the medicine shuts down the body’s natural stress hormone system.5
Despite its seriousness, adrenal suppression is frequently missed in routine care, not because doctors ignore it, but because the symptoms are vague, nonspecific and not routinely screened for unless there’s clinical suspicion.
• Nearly half of oral steroid users develop adrenal suppression — The review reported that 48.7% of patients using long-term oral steroids develop signs of adrenal insufficiency, especially when using daily doses over 20 milligrams (mg) of prednisone for more than two weeks.
This risk is highest in those with chronic conditions requiring prolonged therapy, such as autoimmune diseases, asthma and cancer. In this study, inhaled or topical steroids carried significantly lower systemic risk.
• Symptoms are subtle and mimic many other conditions — Fatigue, nausea, weight loss, dizziness and low blood pressure are common symptoms, but they’re easy to overlook or attribute to other problems. That’s why the study emphasizes the importance of anticipating suppression in high-risk individuals. Without a clear trigger like infection, surgery or physical stress, the underlying adrenal insufficiency often stays hidden until a crisis develops.
• Routine testing is not yet standard, but it should be — The standard test for diagnosing adrenal suppression — the ACTH stimulation test — is rarely used proactively in long-term steroid users. Many patients show no obvious lab abnormalities until an acute event occurs.
The review calls for greater awareness and preemptive screening in people with cumulative steroid exposure, especially when stopping treatment or during periods of illness or stress.
• Dose timing and medication interactions influence risk — The way steroids are taken matters. Multiple daily doses or bedtime administration increase suppression risk by interfering with natural cortisol rhythms.
The review also warned that combining steroids with drugs like the antifungal ketoconazole or the antiviral ritonavir intensify adrenal suppression by slowing steroid breakdown in the liver. These factors often go unaddressed unless clinicians proactively assess each patient’s risk profile.
Steroid Use in Asthma Patients Often Leads to Overlooked Adrenal Suppression
According to a review in the Journal of Internal Medicine, secondary adrenal insufficiency is one of the most serious yet underdiagnosed effects of long-term corticosteroid use, especially in adults with severe asthma.6 Many asthma patients are kept on oral corticosteroids longer than necessary. These patients are often not screened for suppressed adrenal function, even though the consequences, like adrenal crisis, are life-threatening.
• Corticosteroid tapering is risky if adrenal insufficiency isn’t checked for — When patients reduce or stop steroid use too quickly, especially after long-term therapy, their bodies don’t produce enough cortisol to handle stress. The review warns that clinicians often lack guidance on how to safely taper steroids while monitoring for adrenal dysfunction.
In some cases, stopping corticosteroids reveals a hidden problem — the adrenal glands, having been suppressed by long-term steroid use, are no longer functioning properly, which leads to severe symptoms or collapse during illness or surgery.
• Even low to moderate steroid doses impair hormone production — While high doses and long-term use pose the greatest risk, even moderate steroid use, like taking just 5 mg of prednisone a day, or using it at night raises your risk of hormone suppression. Repeated short-term courses — common in asthma flare-ups — have cumulative effects.
Inhaled, intranasal and topical corticosteroids also contribute to this risk, especially when used in combination. Even more concerning, suppression has been reported in patients after just 14 days of corticosteroid treatment, with some showing hormone deficiencies weeks after stopping.
• Routine screening and personalized tapering strategies are urgently needed — The review calls for routine adrenal testing in asthma patients who are tapering off corticosteroids. It also stresses the importance of individualized plans for steroid withdrawal, based not just on dosage but also on symptoms, treatment duration and other medications.
Fix Cortisol Dysfunction by Improving Metabolism
True adrenal insufficiency, where your body literally cannot produce enough cortisol, is rare. It’s known as Addison’s disease and requires lifelong hormone replacement. What’s far more common is dysregulated cortisol metabolism due to inflammation, obesity and poor metabolic health.
Steroid medications, especially when taken long-term, shut down your body’s natural cortisol production. That’s a serious issue, and if you suddenly stop these drugs or fail to manage the root cause, it leaves you vulnerable to dangerous crashes in energy, blood pressure or blood sugar. But, in the absence of steroid use, if your labs show normal cortisol metabolites — even when free cortisol is low — it means you’re making enough. Your body just isn’t using it efficiently.
Instead of turning to more steroids or stimulants, it’s better to focus on calming inflammation, improving your body’s response to insulin and leptin, and helping your stress hormone system, the hypothalamic-pituitary-adrenal (HPA) axis, get back in balance. Here’s how to begin:
1. Cut the root: stop unnecessary steroid use the right way — If you’re taking corticosteroids for mild fatigue or inflammation, you could be making the problem worse. In addition to adrenal problems, long-term steroid use raises your risk of psychiatric symptoms, metabolic syndrome and cardiovascular disease. Taper slowly — not abruptly — and focus on rebuilding your natural cortisol regulation systems.
2. Track both free cortisol and metabolites — A standard ACTH test only flags extreme cortisol highs or lows. But you could be 20% below optimal and still feel awful. That’s where the DUTCH test comes in. It measures not only free cortisol but also downstream metabolites like cortisone. This gives a more accurate picture of how your body produces, converts and clears stress hormones.
3. Fix the upstream problem: insulin resistance and inflammation — If your cortisol is being converted into inactive forms or degraded too quickly, look at your diet and body composition. Cut vegetable oils, as they’re high in linoleic acid, avoid added sugars and ultraprocessed foods, and eat more protein, potassium-rich vegetables, and healthy carbs. These changes help reverse leptin resistance and stabilize blood sugar, both key to proper HPA function.
4. Rebuild your reserve with light, sleep and rhythm — Your body resets cortisol production based on your circadian clock. Get outside first thing in the morning, go to bed at the same time each night, and avoid screens and artificial light after dark. Prioritize deep sleep and eat your meals at consistent times. These simple behaviors send clear hormonal signals that reinforce adrenal balance.
5. Support recovery with adaptogens, but only after the basics — Once you’ve cleaned up your diet, sleep, and inflammation, consider herbal adaptogens. Ashwagandha, tulsi, rhodiola and ginseng (Asian and Siberian) help your body adapt to stress. They modulate the HPA axis, support your thyroid-adrenal link and restore stamina. But they work best when you’ve already addressed the core issues first — don’t use them to cover up deeper imbalances.
FAQs About Steroids and Adrenal Insufficiency
Q: Why are so many people at risk for adrenal suppression from steroids?
A: Steroid medications are prescribed for a wide range of conditions, from asthma and arthritis to eczema and autoimmune disease. Because they’re often seen as routine treatments, many patients stay on them for months or even years without realizing that these drugs shut down their body’s ability to make its own cortisol. The risk increases with dose, duration and repeated use, yet most people aren’t warned about adrenal suppression or tested for it.
Q: How do corticosteroids cause adrenal suppression?
A: Corticosteroids mimic natural cortisol. When used long-term, even at low or moderate doses, they signal your brain to stop producing ACTH, the hormone that tells your adrenal glands to make cortisol. Over time, this feedback loop causes the adrenal glands to shrink and stop functioning, leaving your body dependent on external steroids and unable to respond properly to stress.
Q: Can short-term or inhaled steroids still affect my adrenal glands?
A: Yes. Studies show that adrenal suppression begins after as little as 14 days of corticosteroid use. Even inhaled forms, commonly used for asthma and allergies, are linked to hormone suppression, especially with repeated use or when combined with oral or topical steroids.
Q: Why is adrenal insufficiency so hard to detect?
A: Symptoms like fatigue, nausea, dizziness and low blood pressure are common and nonspecific, so they’re often missed or mistaken for other issues. Most patients aren’t tested unless they’re in crisis or already ill. That’s why proactive screening, especially during tapering or illness, is important for long-term steroid users.
Q: What’s the best way to restore hormone balance after steroid use?
A: Begin by slowly tapering off steroids under supervision. Then focus on reducing inflammation, improving insulin and leptin sensitivity, and supporting your circadian rhythm through light exposure, consistent sleep and regular healthy meals. Once those basics are in place, herbal adaptogens like ashwagandha and rhodiola help restore HPA axis function and energy.
Source: Original Article
Publish Date: 2025-06-14 06:00:00