Glucocorticoid induced adrenal insufficiency

Synthetic glucocorticoids are widely used for their anti-inflammatory and immunosuppressive actions. Apossible unwanted effect of glucocorticoid treatment is suppression of the hypothalamic-pituitaryadrenalaxis, which can lead to adrenal insufficiency. Factors affecting the risk of glucocorticoid inducedadrenal insufficiency(GI-AI) include the duration of glucocorticoid therapy, mode of administration,glucocorticoid dose and potency, concomitant drugs that interfere with glucocorticoid metabolism, andindividual susceptibility. Patients with exogenous glucocorticoid use may develop features of Cushing’ssyndrome and, subsequently,glucocorticoid withdrawal syndrome when the treatment is tapered down.Symptoms of glucocorticoid withdrawal can overlap with those of the underlying disorder, as well as ofGI-AI. A careful approach to the glucocorticoid taper and appropriate patient counseling are needed toassure a successful taper. Glucocorticoid therapy should not be completely stopped until recovery ofadrenal function is achieved.methodologyWe explored databases of PubMed and Google Scholar and identified articles that were publishedbetween ۱۹۹۵ and ۲۰۲۳ with these keywords: "Adrenal insufficiency" "Glucocorticoid" and "GCstherapy" Then we chose about ۷۰ articles and we deleted some of them by our scope.Discussion and ConclusionPatients exposed to exogenous glucocorticoids are at risk of developing GI-AI, which needs to bepromptly recognized, anticipated, and optimally managed. Patients treated with high doses ofglucocorticoids for a longer duration may develop severe GWS when the treatment is tapered down.Individualized glucocorticoid taper can help with symptoms of glucocorticoid withdrawal and a quickereventual recovery of adrenal function. Every patient with GI-AI should receive optimal education onmanagement of adrenal insufficiency, including management of glucocorticoid therapy during an illness.Guidelines need to be developed to cover gaps in the management of patients treated with chronicglucocorticoids to raise awareness of GI-AI and GWS and provide clear recommendations that can beapplied in the interdisciplinary setting.

Keywords:

Adrenal insufficiency , Glucocorticoid , receptor , GI-AI , therapy