New Guidelines for the Management of Corticosteroid-Induced Adrenal Insufficiency – J Clin Endocrinol Metab

Introduction: 

The European Society of Endocrinology and the Endocrine Society have co-published the first joint clinical guideline, focusing on the diagnosis and therapy for glucocorticoid-induced adrenal insufficiency. This document serves as an essential tool for health professionals involved in the care of patients undergoing chronic glucocorticoid therapy.

Key Points:

• Patient Education: Clinicians are recommended to inform patients about the endocrine effects of glucocorticoid treatment, particularly in relation to adrenal insufficiency.
• No Tapering in Short-Term Therapies: It is suggested not to taper glucocorticoid therapies of short duration (<3-4 weeks), regardless of the dose.
• Careful Tapering: For long-term therapies, tapering should be done gradually, especially when approaching physiological daily equivalent doses (e.g., 4-6 mg of prednisone).
• Monitoring Withdrawal Syndrome: Consideration of glucocorticoid withdrawal syndrome that may occur during tapering, adjusting the dose as needed to alleviate symptoms.
• Testing for Adrenal Insufficiency: Morning serum cortisol is recommended as the first test in the suspicion of disorders in the recovery of the HPA axis after cessation of glucocorticoids.

These guidelines offer practical and evidence-based guidance for managing patients who develop adrenal insufficiency due to prolonged use of glucocorticoids, emphasizing the importance of patient education and careful monitoring during the tapering process.

Reference (link to free full-text):

Beuschlein, F., et al. (2024). European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency. The Journal of Clinical Endocrinology & Metabolism. Available at: https://doi.org/10.1210/clinem/dgae250