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Highlights & Basics
- Adrenal suppression is the inadequate adrenal production of cortisol due to suppression of the hypothalamic-pituitary-adrenal axis.
- It may present clinically as adrenal insufficiency in instances of rapid tapering or cessation of exogenous glucocorticoids or withdrawal from endogenous glucocorticoid excess (e.g., following treatment of Cushing disease or an adrenal tumor causing Cushing syndrome).
- The adrenocorticotropic hormone stimulation test is generally the most useful test to detect adrenal suppression.
- Preventive measures include minimizing corticosteroid dose and duration when possible.
- Treatment consists of augmented corticosteroid therapy plus supportive care for any intercurrent stress or overt signs of adrenal insufficiency.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Prete A, Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ. 2021 Jul 12;374:n1380.[Abstract][Full Text]
Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013 Aug 15;9(1):30.[Abstract][Full Text]
Beuschlein F, Else T, Bancos I, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. J Clin Endocrinol Metab. 2024 Jun 17;109(7):1657-83.[Abstract][Full Text]
Arlt W; Society for Endocrinology Clinical Committee. Society for Endocrinology endocrine emergency guidance: emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients. Endocr Connect. 2016 Sep;5(5):G1-3.[Abstract][Full Text]
Woodcock T, Barker P, Daniel S, et al. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. Anaesthesia. 2020 May;75(5):654-63.[Abstract][Full Text]
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