Leukocytosis may be an indicator of replacement with supraphysiological dose in adrenal insufficiency: relationship with comorbidities and impaired muscle strength.

Leukocytosis was present in 17 patients and neutrophilia in 10 patients among 98 adrenal insufficiency patients receiving glucocorticoid replacement therapy.

• The cohort of 98 patients had a median age of 41.5 years and was 49% female.
• Patients had primary or secondary adrenal insufficiency receiving physiologic doses of glucocorticoid replacement.
• 17 of 98 patients (approximately 17%) had leukocytosis and 10 of 98 (approximately 10%) had neutrophilia.

Patients with leukocytosis were significantly more likely to have hypertension, dyslipidemia, and metabolic syndrome.

• Hypertension was more prevalent in patients with leukocytosis (p = 0.001).
• Dyslipidemia was more prevalent in patients with leukocytosis (p < 0.001).
• Metabolic syndrome was more prevalent in patients with leukocytosis (p = 0.006).
• Patients with leukocytosis also had increased BMI, waist, and hip circumferences.

Hand grip strength was lower in patients with leukocytosis compared to those without.

• Reduced muscle strength was observed in adrenal insufficiency patients who had leukocytosis.
• A leukocyte count of >8550/mm³ predicted reduced muscle strength with a sensitivity of 62.5% and specificity of 58.1%.
• Quality of life, hand-grip strength, and body composition were formally assessed as part of the study protocol.

Multivariate analysis identified leukocyte count, age, and poor quality of life as predictors of having two or more comorbidities.

• The multivariate analysis examined predictors of ≥2 comorbidities in the study cohort.
• Three independent predictors were identified: leukocyte count, age, and poor quality of life.
• This analysis supports leukocyte count as an independent indicator of glucocorticoid-related metabolic burden.

No laboratory markers are currently available to predict adverse metabolic effects of supraphysiological glucocorticoid dosing in adrenal insufficiency patients.

• Patients with adrenal insufficiency receiving glucocorticoid replacement may occasionally be exposed to supraphysiological doses.
• Supraphysiological glucocorticoid exposure can lead to metabolic complications and sarcopenia.
• The study was motivated by the absence of existing laboratory markers to predict these adverse effects.

Leukocytosis may serve as an indicator of supraphysiological glucocorticoid exposure and may indicate the need for glucocorticoid dose adjustment in adrenal insufficiency patients.

• The association between leukocytosis and metabolic complications mirrors findings seen in patients with excess endogenous or exogenous glucocorticoid exposure.
• The study authors suggest leukocytosis may indicate the need for glucocorticoid dose adjustment.
• Hemogram parameters, specifically leukocyte and neutrophil counts, were evaluated as potential indicators of supraphysiological dosing.