Why glucocorticoid withdrawal may sometimes be as dangerous as the treatment itself

Dinsen, Stina; Baslund, Bo; Klose, Marianne; Rasmussen, Åase Krogh; Friis‐Hansen, Lennart; Hilsted, Linda; Feldt‐Rasmussen, Ulla

doi:10.1016/j.ejim.2013.05.014

Cited by 118 publications

(104 citation statements)

References 66 publications

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“…15,16,18 The true risk of adrenal crisis in patients with glucocorticoid-induced adrenal insufficiency is difficult to determine, as they form a heterogeneous group and only limited case reports are available. 22,23 It is important, nevertheless, to recognize that the most common cause of adrenal insufficiency is use of exogenous steroids, 3 and these patients are similarly at risk of adrenal crisis. Sudden, and often inadvertent, withdrawal of steroids can lead to adrenal crisis.…”

Section: Risk Factorsmentioning

confidence: 99%

Adrenal Crisis: Still a Deadly Event in the 21st Century

Puar

Stikkelbroeck

Smans

et al. 2016

The American Journal of Medicine

131

137

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Adrenal crisis is a life-threatening medical emergency, associated with a high mortality unless it is appropriately recognized and early treatment is rendered. Despite it being a treatable condition for almost 70 years, failure of adequate preventive measures or delayed treatment has often led to unnecessary deaths. Gastrointestinal illness is the most common precipitant for an adrenal crisis. Although most patients are educated about "sick day rules," patients, and physicians too, are often reluctant to increase their glucocorticoid doses or switch to parenteral injections, and thereby fail to avert the rapid deterioration of the patients' condition. Therefore, more can be done to prevent an adrenal crisis, as well as to ensure that adequate acute medical care is instituted after a crisis has occurred. There is generally a paucity of studies on adrenal crisis. Hence, we will review the current literature, while also focusing on the incidence, presentation, treatment, prevention strategies, and latest recommendations in terms of steroid dosing in stress situations.

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Section: Risk Factorsmentioning

confidence: 99%

Adrenal Crisis: Still a Deadly Event in the 21st Century

Puar

Stikkelbroeck

Smans

et al. 2016

The American Journal of Medicine

131

137

View full text Add to dashboard Cite

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“…IT IS WELL KNOWN that prolonged use of glucocorticoids is associated with suppression of the hypothalamic-pituitary-adrenal (HPA) axis [1]. The degree of HPA axis suppression may be influenced by factors including the dose and duration of glucocorticoid administration.…”

mentioning

confidence: 99%

High incidence of adrenal suppression in children with Kawasaki disease treated with intravenous immunoglobulin plus prednisolone

et al. 2015

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“…Interpretation of these investigations typically relies on historic, single-value diagnostic cutoffs with minimal consideration of assay-specific biases (3 ). In addition, cortisol quantification aids the assessment of adrenal reserve following chronic exogenous glucocorticoid therapy (4,5 ). In the management of Cushing syndrome, cortisol concentrations are used to help guide the appropriate dosing of metyrapone, a potent 11␤-hydroxylase inhibitor (6 ).…”

mentioning

confidence: 99%