PURPOSE

Patients with adrenal insufficiency (AI) receiving glucocorticoid replacement therapy may occasionally be exposed to supraphysiological doses, which can lead to metabolic complications and sarcopenia. Currently, there are no laboratory markers available to predict these adverse effects. This study investigates the relationship between leukocytosis, neutrophilia, and the comorbidities associated with excess glucocorticoid exposure, and evaluates whether hemogram parameters can serve as indicators of supraphysiological glucocorticoid dosing.

METHODS

Ninety-eight patients with primary or secondary AI receiving physiologic doses of glucocorticoid replacement were evaluated. Demographic data, laboratory findings, medications, comorbidities, and hemogram parameters were obtained from patient records. Quality of life, hand-grip strength, and body composition were assessed. Patients were examined for parameters associated with leukocytosis.

RESULTS

The cohort (49% female) had a median age of 41.5 years. Leukocytosis was present in 17 patients, and neutrophilia in 10 patients. Patients with leukocytosis were more likely to have hypertension, dyslipidemia, and metabolic syndrome (p = 0.001; <0.001; 0.006, respectively) and had increased BMI, waist, and hip circumferences. Hand grip strength was lower in patients with leukocytosis. A leukocyte count of > 8550/mm predicted reduced muscle strength (sensitivity 62.5%, specificity 58.1%). Multivariate analysis identified leucocyte count, age, and poor quality of life as predictors of ≥ 2 comorbidities.

CONCLUSION

Leukocytosis in patients with adrenal insufficiency on glucocorticoid replacement therapy is associated with metabolic complications and reduced muscle strength Leukocytosis may be a marker of supraphysiological GC exposure and may indicate the need for GC dose adjustment in these individuals.