European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency

Author:

Beuschlein Felix123ORCID,Else Tobias4ORCID,Bancos Irina56ORCID,Hahner Stefanie7,Hamidi Oksana8ORCID,van Hulsteijn Leonie910ORCID,Husebye Eystein S1112,Karavitaki Niki131415,Prete Alessandro131416,Vaidya Anand17ORCID,Yedinak Christine18,Dekkers Olaf M101920

Affiliation:

1. Department of Endocrinology, Diabetology and Clinical Nutrition, University of Zürich (USZ) and University of Zürich (UZH) , 8091 Zürich , Switzerland

2. Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität , 81377 Munich , Germany

3. The LOOP Zurich Medical Research Center , 8044 Zurich , Switzerland

4. Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan , Ann Arbor, MI 48109 , USA

5. Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester , MN 55905 , USA

6. Joint appointment in Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester , MN 55905 , USA

7. Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg , 97080 Wuerzburg , Germany

8. Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center , Dallas, TX 75390-8857 , USA

9. European Society of Endocrinology , Bristol BS32 4QW , UK

10. Department of Clinical Epidemiology, Leiden University Medical Center , 2333 ZA Leiden , The Netherlands

11. Department of Clinical Science, University of Bergen , N-5021 Bergen , Norway

12. Department of Medicine, Haukeland University Hospital , N-5021 Bergen , Norway

13. Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham , Birmingham B15 2TT , UK

14. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners , Birmingham B15 2TT , UK

15. Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust , Birmingham B15 2TH , UK

16. NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust , Birmingham B15 2TH , UK

17. Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School , Boston, MA 02115 , USA

18. Department of Neurological Surgery, Oregon Health & Sciences University , Portland, OR 97239-3098 , USA

19. Department of Endocrinology and Metabolism, Leiden University Medical Center , 2333 ZA Leiden , The Netherlands

20. Department of Clinical Epidemiology, Aarhus University , 8200 Aarhus , Denmark

Abstract

Abstract Glucocorticoids are widely prescribed as anti-inflammatory and immunosuppressive agents. This results in at least 1% of the population using chronic glucocorticoid therapy, being at risk for glucocorticoid-induced adrenal insufficiency. This risk is dependent on the dose, duration and potency of the glucocorticoid, route of administration, and individual susceptibility. Once glucocorticoid-induced adrenal insufficiency develops or is suspected, it necessitates careful education and management of affected patients. Tapering glucocorticoids can be challenging when symptoms of glucocorticoid withdrawal develop, which overlap with those of adrenal insufficiency. In general, tapering of glucocorticoids can be more rapidly within a supraphysiological range, followed by a slower taper when on physiological glucocorticoid dosing. The degree and persistence of HPA axis suppression after cessation of glucocorticoid therapy are dependent on overall exposure and recovery of adrenal function varies greatly amongst individuals. This first European Society of Endocrinology/Endocrine Society joint clinical practice guideline provides guidance on this clinically relevant condition to aid clinicians involved in the care of patients on chronic glucocorticoid therapy.

Funder

European Society of Endocrinology

Publisher

The Endocrine Society

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