Objective: The action of inhalation and systemic treatment of chronic obstructive pulmonary disease by suppressing the hypothalamo-hypophyseal-adrenal axis was compared in patients with chronic obstructive pulmonary disease (COPD).
Patients and methods: Adrenocorticotropic hormone (ACTH) and cortisol concentrations were evaluated after a corticotropin-releasing-hormone (CRH)-test in 50 patients (aged 43 +/- 14 years) with chronic obstructive pulmonary disease (COPD) receiving inhalant glucocorticoid treatment (IGC), 61 patients (aged 54 +/- 11 years) with COPD on systemic glucocorticoid treatment (SGC) and 50 healthy volunteers (32 +/- 4 years).
Results: All 50 patients on IGC had normal CRH test results. 30 of 61 patients with SGC had decreased cortisol response (12 patients had no and 18 a reduced rise in cortisol). ACTH concentration was lower in patients on IGC than in the control group (basal ACTH 15.6 pg/ml and 24.5 pg/ml, respectively; after stimulation 40.3 vs 54.4 pg/ml, respectively). But systemic glucocorticoid treatment clearly caused suppression of basal (12.1 pg/ml) and stimulated (27.4 pg/ml) ACTH levels with correspondingly decreased cortisol levels (basal: 75.1 and 118.7 ng/ml [IGC], respectively, and after stimulation 128.5 and 225.9 ng/ml).
Conclusions: Patients with COPD on inhalant glucocorticoid treatment have a clearly lower risk of adrenal cortical insufficiency than those on oral glucocorticoid treatment. But some suppression of ACTH secretion is demonstrable even in the former. Clinical significance of these findings seems unlikely. Development of adrenal cortical insufficiency need not be feared in patients treated with inhalant glucocorticoids.