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:10.1210/clinem/dgae250

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

^*Corresponding author for this work

Department of Clinical Medicine - Department of Clinical Epidemiology

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

20 Citations (Scopus)

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.

Original language	English
Journal	Journal of Clinical Endocrinology and Metabolism
Volume	109
Issue	7
Pages (from-to)	1657-1683
Number of pages	27
ISSN	0021-972X
DOIs	https://doi.org/10.1210/clinem/dgae250
Publication status	Published - Jul 2024

Keywords

adrenal crisis
adrenal insufficiency
glucocorticoid withdrawal
glucocorticoids
steroids
substitution therapy

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10.1210/clinem/dgae250Licence: CC BY-NC

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Beuschlein, F., Else, T., Bancos, I., Hahner, S., Hamidi, O., Van Hulsteijn, L., Husebye, E. S., Karavitaki, N., Prete, A., Vaidya, A., Yedinak, C., & Dekkers, O. M. (2024). European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency. Journal of Clinical Endocrinology and Metabolism, 109(7), 1657-1683. https://doi.org/10.1210/clinem/dgae250

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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.",

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author = "Felix Beuschlein and Tobias Else and Irina Bancos and Stefanie Hahner and Oksana Hamidi and {Van Hulsteijn}, Leonie and Husebye, {Eystein S.} and Niki Karavitaki and Alessandro Prete and Anand Vaidya and Christine Yedinak and Dekkers, {Olaf M.}",

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doi = "10.1210/clinem/dgae250",

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Beuschlein, F, Else, T, Bancos, I, Hahner, S, Hamidi, O, Van Hulsteijn, L, Husebye, ES, Karavitaki, N, Prete, A, Vaidya, A, Yedinak, C & Dekkers, OM 2024, 'European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency', Journal of Clinical Endocrinology and Metabolism, vol. 109, no. 7, pp. 1657-1683. https://doi.org/10.1210/clinem/dgae250

European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency. / Beuschlein, Felix; Else, Tobias; Bancos, Irina et al.
In: Journal of Clinical Endocrinology and Metabolism, Vol. 109, No. 7, 07.2024, p. 1657-1683.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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

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