Glucocorticoid Withdrawal—An Overview on When and How to Diagnose Adrenal Insufficiency in Clinical Practice

Abstract

Glucocorticoids (GCs) are widely used due to their anti-inflammatory and immunosuppressive effects. As many as 1–3% of the population are currently on GC treatment. Prolonged therapy with GCs is associated with an increased risk of GC-induced adrenal insufficiency (AI). AI is a rare and often underdiagnosed clinical condition characterized by deficient GC production by the adrenal cortex. AI can be life-threatening; therefore, it is essential to know how to diagnose and treat this disorder. Not only oral but also inhalation, topical, nasal, intra-articular and intravenous administration of GCs may lead to adrenal suppression. Moreover, recent studies have proven that short-term (<4 weeks), as well as low-dose (<5 mg prednisone equivalent per day) GC treatment can also suppress the hypothalamic–pituitary–adrenal axis. Chronic therapy with GCs is the most common cause of AI. GC-induced AI remains challenging for clinicians in everyday patient care. Properly conducted GC withdrawal is crucial in preventing GC-induced AI; however, adrenal suppression may occur despite following recommended GC tapering regimens. A suspicion of GC-induced AI requires careful diagnostic workup and prompt introduction of a GC replacement treatment. The present review provides a summary of current knowledge on the management of GC-induced AI, including diagnostic methods, treatment schedules, and GC withdrawal regimens in adults.

High Levels of C-Reactive Protein with Low Levels of Pentraxin 3 as Biomarkers for Central Serous Chorioretinopathy

“… 37 , 38 The diagnosis of such infraclinical adrenal insufficiency might be very difficult to detect. 39 It can therefore not be excluded in those patients with CSCR who have been treated even several months or years ago with glucocorticoids and might present with relative adrenal insufficiency.…”

Management of adrenal insufficiency: A survey of perceptions and practices of physicians from the Middle East and North Africa

“…[23] Furthermore, it has been demonstrated that 68% of patients with AI had an incorrect diagnosis at first. [24] However, in none of the studies, information was available on the physicians' education, knowledge on GC replacement, or medical specialty. The findings of the present study and the two previous studies [9,10] fill this gap in various professional groups and support the idea to provide ongoing education to physicians on AI, a rare but essential disorder since patients rely in large parts on the information provided by their physicians.…”

Relapses of pain syndrome in patients with polymyalgia rheumatica during reduction of glucocorticoid therapy

“…Рекомендуется заменить обычно применяющиеся препараты средней длительности действия (преднизолон, метилпреднизолон) на гидрокортизон для приема внутрь (2 или 3 приема в день) [12,13]. По мнению эндокринологов, относительно короткое действие гидрокортизона способствует восстановлению функции оси гипоталамусгипофиз-надпочечники в промежутках между приемами препарата [14]. Суточная доза гидрокортизона устанавливается индивидуально и с учетом той дозы ГК, которая применялась в период исследования уровня кортизола в крови.…”