Glucocorticoid-induced adrenal suppression and metabolic syndrome in glucocorticoid treated AECOPD patients related to different gene polymorphisms of the glucocorticoid receptor gene

Background: Glucocorticoids (GCs) are widely used in patients with acute exacerbation of COPD. Single-nucleotide polymorphism (SNP) of the GC receptor gene (NR3C1) has been associated with individual differences in GC sensitivity and may be linked to response to GC-treatment. Objectives: i) Assess the prevalence of adrenal suppression (AS) in severe COPD patients 1 month after GCs course for exacerbation ii) Whether high GC sensitivity SNPs (BclI-G or N363S-G) is associated with increased AS and metabolic syndrome compared with SNPs associated with low GC sensitivity(ER22/23EK, 9β, wild type and mixed type). Methods: Observational prospective cohort study, we recruited 76 patients between 2017—2019 with severe COPD treated with 5 days of GCs. All patients were genotyped for all 4 SNPs. Results: AS frequency (corticotropin stimulated P-cortisol≤420 nmol/l) was 5.4% after 1-month. No difference was observed in baseline characteristics, the frequency of AS or other metabolic outcomes (figure 1) between high GC sensitivity and the low GC sensitivity genotypes. Conclusions: Carrier status of the BclI-G or N363S-G alleles was not associated with the development of AS or metabolic syndrome at 1-month after completing GC treatment, suggesting that genotyping for these SNPs can not identify COPD patients with a high risk of side effects.