Guideline Developed for Glucocorticoid-Induced Adrenal Insufficiency

Tapering glucocorticoids can be challenging when symptoms of glucocorticoid withdrawal develop
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Medically Reviewed By:
Mark Arredondo, M.D.

MONDAY, May 20, 2024 (HealthDay News) -- In a clinical guideline issued jointly by the European Society of Endocrinology and the Endocrine Society, recommendations are presented for the diagnosis and management of glucocorticoid-induced adrenal insufficiency. The guideline was published online May 8 simultaneously in the European Journal of Endocrinology and the Journal of Clinical Endocrinology & Metabolism.

Noting that at least 1 percent of the population using chronic glucocorticoid therapy is at risk for glucocorticoid-induced adrenal insufficiency, Felix Beuschlein, M.D., from the University of Zurich, and colleagues note that the risk is dependent on the dose, duration, and potency of the glucocorticoid, as well as route of administration and individual susceptibility. Careful education and management of affected patients is required once glucocorticoid-induced adrenal insufficiency develops or is suspected.

The researchers note that when symptoms of glucocorticoid withdrawal develop, which overlap with those of adrenal insufficiency, tapering glucocorticoids can be challenging. They recommend that glucocorticoid tapering can be more rapid when in a supraphysiological range and followed by a slower taper on physiological dosing. After cessation of glucocorticoid therapy, the degree and persistence of hypothalamic-pituitary-adrenal axis suppression are dependent on overall exposure; recovery of adrenal function varies greatly among individuals.

"Our starting point was to define the clinical problem and knowledge gaps that come with glucocorticoid-induced adrenal insufficiency, for which we set out to provide some guidance -- even in the absence of strong scientific evidence," Beuschlein said in a statement.

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