Overview
Iatrogenic adrenal insufficiency arises from the suppression of adrenal function due to exogenous steroid administration, leading to adrenal axis dysfunction and potential adrenal insufficiency upon withdrawal or stress.Diagnosis
Perform baseline cortisol levels and ACTH stimulation tests (short synacthen test) to assess adrenal reserve 2.
Evaluate clinical symptoms such as fatigue, hypotension, and hyperpigmentation if applicable.
Consider serial cortisol measurements post-stimulation to confirm recovery in patients with central adrenal insufficiency 2.Management
Gradually taper exogenous steroid doses under close monitoring to minimize adrenal suppression 2.
Initiate stress doses of glucocorticoids during acute illness or surgery in at-risk patients 2.
Monitor for signs of adrenal insufficiency and adjust management accordingly, possibly including mineralocorticoid replacement if indicated 2.Special Populations
No specific guidance provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts 1.Key Recommendations
Utilize the short synacthen test for assessing recovery of adrenal function in patients with central adrenal insufficiency (Evidence: Moderate) 2.
Gradually taper exogenous steroids to prevent iatrogenic adrenal insufficiency, closely monitoring patients for signs of adrenal dysfunction (Evidence: Expert opinion) 2.
Administer stress doses of glucocorticoids during critical periods such as surgery or acute illness in patients at risk of adrenal insufficiency (Evidence: Expert opinion) 2.References
1 Manzocchi S, van Rooyen LJ. Are analytical performance specifications derived from reference intervals of any use in the veterinary clinical laboratory? A preliminary study on the empirical biological variation model. Veterinary clinical pathology 2024. link
2 Sherlock M, Stewart PM. The Short Synacthen Test and Its Utility in Assessing Recovery of Adrenal Function in Patients With Central Adrenal Insufficiency. The Journal of clinical endocrinology and metabolism 2019. link