STATE OF THE ART REVIEW Glucocorticoid induced adrenal insufficiency BMJ: first published as 10.1136/bmj.n1380 on 12 July 2021. Downloaded from Alessandro Prete,1 Irina Bancos2 ABSTRACT 1 Synthetic glucocorticoids are widely used for their anti-inflammatory and Institute of Metabolism and Systems Research, University of immunosuppressive actions. A possible unwanted effect of glucocorticoid treatment Birmingham, Birmingham, UK 2Division of Endocrinology, is suppression of the hypothalamic-pituitary-adrenal axis, which can lead to adrenal Metabolism and Nutrition, insufficiency. Factors affecting the risk of glucocorticoid induced adrenal insufficiency Department of Internal Medicine, Mayo Clinic, (GI-AI) include the duration of glucocorticoid therapy, mode of administration, Rochester, MN 55905, USA Correspondence to: I Bancos glucocorticoid dose and potency, concomitant drugs that interfere with
[email protected] glucocorticoid metabolism, and individual susceptibility. Patients with exogenous (ORCID 0000-0001-9332-2524) Cite this as: BMJ 2021;374:n1380 glucocorticoid use may develop features of Cushing’s syndrome and, subsequently, http://dx.doi.org/10.1136/bmj.n1380 glucocorticoid withdrawal syndrome when the treatment is tapered down. Symptoms Series explanation: State of the Art Reviews are commissioned of glucocorticoid withdrawal can overlap with those of the underlying disorder, as on the basis of their relevance to academics and specialists well as of GI-AI. A careful approach to the glucocorticoid taper and appropriate in the US and internationally. patient counseling are needed to assure a successful taper. Glucocorticoid therapy For this reason they are written predominantly by US authors. should not be completely stopped until recovery of adrenal function is achieved. In this review, we discuss the factors affecting the risk of GI-AI, propose a regimen for the glucocorticoid taper, and make suggestions for assessment of adrenal function recovery.