European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency

Felix Beuschlein; Tobias Else; Irina Bancos; Stefanie Hahner; Oksana Hamidi; Leonie van Hulsteijn; Eystein S Husebye; Niki Karavitaki; Alessandro Prete; Anand Vaidya; Christine Yedinak; Olaf M Dekkers

doi:10.1093/ejendo/lvae029

European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency

Eur J Endocrinol. 2024 May 2;190(5):G25-G51. doi: 10.1093/ejendo/lvae029.

Authors

Felix Beuschlein^{1

2

3}, Tobias Else⁴, Irina Bancos^{5

6}, Stefanie Hahner⁷, Oksana Hamidi⁸, Leonie van Hulsteijn^{9

10}, Eystein S Husebye^{11

12}, Niki Karavitaki^{13

14

15}, Alessandro Prete^{13

14

16}, Anand Vaidya¹⁷, Christine Yedinak¹⁸, Olaf M Dekkers^{10

19

20}

Affiliations

¹ Department of Endocrinology, Diabetology and Clinical Nutrition, University of Zürich (USZ) and University of Zürich (UZH), Zürich, Switzerland.
² Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany.
³ The LOOP Zurich Medical Research Center, 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 Rocheste r, MN 55905, US.
⁶ Joint appointment in Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN 55905, US.
⁷ Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Germany.
⁸ Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁹ European Society of Endocrinology, Bristol, UK.
¹⁰ Department of Clinical Epidemiology, Leiden University Medical Center, 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.
¹³ Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
¹⁴ Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
¹⁵ Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁶ NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁷ Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁸ Department of Neurological Surgery, Oregon Health & Sciences University, Portland, Oregon, USA.
¹⁹ Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, The Netherlands.
²⁰ Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.

PMID: 38714321
DOI: 10.1093/ejendo/lvae029

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.

Keywords: Adrenal insufficiency; adrenal crisis; glucocorticoid withdrawal; glucocorticoids; steroids; substitution therapy.

This article has been co-published with permission in European Journal of Endocrinology and The Journal of Clinical Endocrinology & Metabolism © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Endocrinology.

Publication types

Practice Guideline

MeSH terms

Adrenal Insufficiency* / chemically induced
Adrenal Insufficiency* / diagnosis
Adrenal Insufficiency* / drug therapy
Adrenal Insufficiency* / therapy
Endocrinology* / methods
Endocrinology* / standards
Europe
Glucocorticoids* / administration & dosage
Glucocorticoids* / adverse effects
Glucocorticoids* / therapeutic use
Humans
Societies, Medical / standards

Substances

Glucocorticoids

Grants and funding

European Society of Endocrinology