Glucocorticoid-induced adrenal insufficiency

Abstract

Currently, systemic glucocorticoids are taken by about 1–3% of the general population, up to 1.8% long-term. Moreover, about 50% of patients taking these drugs orally develop glucocorticoid-induced adrenal insufficiency (GIAI) after their withdrawal. Despite this scale of the problem and the length of time the issue has been studied, there are currently no standard algorithms for reducing the dose or discontinuing glucocorticoids. The evidence base on this issue has been performed on relatively few clinical studies, which are extremely heterogeneous with respect to the populations studied, designs, regimens of glucocorticoid use, and diagnostic approaches to adrenal insufficiency. Thus, the weight of evidence on this issue remains inadequate, resulting in each institution having its own approach to dose reduction and discontinuation of glucocorticoids, or no approach at all. This article summarizes current information about GIAI, allowing for improved approaches to dose reduction or discontinuation of glucocorticoids. Improving the management tactics of patients who have been receiving glucocorticoids for a long time will lead to a reduction in the risk of complications of GIAI, including life-threatening ones, as well as to a significant improvement in the quality of life of patients.

Keywords

• adrenal insufficiency
• glucocorticoids
• drug withdrawal symptoms