Endocrinol Metab.  2024 Aug;39(4):569-572. 10.3803/EnM.2024.2065.

Bridging Gaps Amidst Limited Evidence for Glucocorticoid-Induced Adrenal Insufficiency

• Lee SH

• KMID: 2558939
• DOI: http://doi.org/10.3803/EnM.2024.2065

Figure

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  Fig. 1. Two proposed approaches to systemic glucocorticoid (GC) discontinuation. HCS, hydrocortisone; PD, prednisone; PDL, prednisolone; MPD, methylprednisolone; DXM, dexamethasone; AI, adrenal insufficiency; NA, not applicable; CBG, cortisol binding globulin. aExogenous GC should not be reduced below the lower end of the physiologic replacement dose range to ensure adequate replacement for AI, yet still providing a stimulus for hypothalamic-pituitary-adrenal (HPA) axis recovery. Further significant dose reduction should only occur with indication of HPA axis recovery; bSome patients with cortisol values close to the proposed 10.0 μg/dL (300 nmol/L) cutoff may still have a degree of suboptimal cortisol response when exposed to major stress. Rely on clinical judgement and offer stress GC coverage if AI is suspected in such cases. Dynamic testing may be considered; cSome patients may develop GC withdrawal symptoms (e.g., those who have been on supraphysiologic doses for a very long time) and may benefit from gradual tapering rather than an abrupt discontinuation.

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