Management of endocrine disease: glucocorticoid-induced adrenal insufficiency: replace while we wait for evidence?
Open accessAbstract
Glucocorticoids are, besides non-steroidal anti-inflammatory drugs, the most widely used anti-inflammatory medications. Prevalence studies indicate substantial use of both systemic and locally acting agents. A recognised adverse effect of glucocorticoid treatment is adrenal insufficiency, which is highly prevalent based on biochemical testing, but its clinical implications are poorly understood. Current evidence, including randomised trials and observational studies, indicates substantial variation among patients in both risk and course of glucocorticoid-induced adrenal insufficiency, but both are currently unpredictable. Oral and intra-articular formulations, as well as long-term and high-dose treatments, carry the highest risk of glucocorticoid-induced adrenal insufficiency defined by biochemical tests. However, no route of administration, treatment duration, or dose can be considered without risk. More research is needed to estimate the risk and temporal pattern of glucocorticoid-induced adrenal insufficiency, to investigate its clinical implications, and to identify predictors of risk and prognosis. Randomized trials are required to evaluate whether hydrocortisone replacement therapy mitigates risk and symptoms of glucocorticoid-induced adrenal insufficiency in patients discontinuing glucocorticoid treatment. This review aims to provide an overview of the available evidence, pointing to knowledge gaps and unmet needs.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Clinically relevant AI may arise after abrupt or inappropriately managed withdrawal of glucocorticoids, especially in patients taking oral and intra-articular long-acting formulations, high glucocorticoid doses, and long treatment regimens.
“Clinically relevant AI may arise after abrupt or inappropriately managed withdrawal of glucocorticoids, especially in patients taking oral and intra-articular long-acting formulations, high glucocorticoid doses, and long treatment regimens (15, 16).”
From The Changing Face of Drug-induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System (2022) · cites this paper as [15]
The Highlights and Dose and duration sections identify oral and intra-articular administration, high doses, and prolonged treatment as risk factors for glucocorticoid-induced adrenal insufficiency. The Occurrence section documents insufficiency during or around cessation, but the Clinical practice section says it remains unclear how often biochemically diagnosed insufficiency causes clinically relevant morbidity. The paper does not establish that abrupt or inappropriately managed withdrawal is the particular trigger, or that the higher-risk formulations are specifically long-acting. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEven though treatment regimens, route of administration, potency, dose, duration of glucocorticoid treatment, as well as individual glucocorticoid sensitivity, have been postulated as potential risk factors for glucocorticoid-induced AI, no clear-cut predictive factors of risk of onset and duration of AI before HPA axis recovery have been identified so far.
“Even though treatment regimens, route of administration, potency, dose, duration of glucocorticoid treatment, as well as individual glucocorticoid sensitivity, have been postulated as potential risk factors for glucocorticoid-induced AI, no clear-cut predictive factors of risk of onset and duration of AI before HPA axis recovery have been identified so far (15, 16, 20, 21).”
From The Changing Face of Drug-induced Adrenal Insufficiency in the Food and Drug Administration Adverse Event Reporting System (2022) · cites this paper as [15]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 31 · Cited by 32
Research works printed but not linked: 2
- Rodger RS, Watson MJ, Sellars L, Wilkinson R, Ward MK & Kerr DN. Hypothalamic-pituitary-adrenocortical suppression and recovery in renal transplant patients returning to maintenance dialysis. Quarterly Journal of Medicine 1986 61 1039-1046.
- Saracco P, Bertorello N, Farinasso L, Einaudi S, Barisone E, Altare F, Corrias A & Pastore G. Steroid withdrawal syndrome during steroid tapering in childhood acute lymphoblastic leukemia: a controlled study comparing prednisone versus dexamethasone in induction phase. Journal of Pediatric Hematology/Oncology 2005 27 141-144. (https://doi.org/10.1097/01.mph.0000155870.38794.e7) · DOI
- Authors
- Laugesen, K., Broersen, L. H. A., Hansen, S. B., Dekkers, O. M., Sørensen, H. T., & Jorgensen, J. O. L.
- Affiliations
- Aarhus University Hospital (DK)
- Leiden University Medical Center (NL)
- 4Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- ORCID
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-04
- Volume
- 184
- Issue
- 4
- Pages
- R111-R122
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W3123108017
- Cited by
- 32
- References
- 31
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 8 · 2023: 9 · 2022: 10 · 2021: 2
- FWCI
- 1.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion)
- Funders
- Novo Nordisk Fonden (NNF-13OC0007869, NNF20OC0063280)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- glucocorticoid-induced adrenal insufficiency, hydrocortisone replacement, glucocorticoids, intra-articular glucocorticoids, glucocorticoid adverse effects, intra-articular corticosteroids
- MeSH terms
- Adrenal Insufficiency, Anti-Inflammatory Agents, Glucocorticoids, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Hormone Replacement Therapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
