Summary

• Pathophysiology involves suppression of the hypothalamic-pituitary-adrenal axis.
• Symptoms may be related to rapid tapering or cessation of exogenous glucocorticoids (resulting in a form of secondary adrenal insufficiency) or withdrawal from endogenous glucocorticoid excess (e.g., Cushing's syndrome after treatment). Even locally administered glucocorticoids may result in adrenal suppression.
• The adrenocorticotropic hormone stimulation test is generally the most useful test to detect adrenal suppression.
• Treatment consists of augmented corticosteroid therapy plus supportive care for any intercurrent stress or overt signs of adrenal insufficiency. Preventive measures include minimising corticosteroid dose and duration when possible.