When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Adrenal suppression

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 16 Aug 2025
Last updated: 02 May 2025

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • presence of risk factors
  • sudden cessation or rapid tapering of glucocorticoids
  • acute circulatory collapse with hypotension and tachycardia
Detalhes completos

Outros fatores diagnósticos

  • lassitude and generalized constitutional symptoms
  • history of weight gain and increased appetite
  • history of depression, agitation, or sleep disorders
  • cushingoid exam features
  • history of difficult-to-control diabetes or hypertension
  • absence of hyperpigmentation or autoimmune stigmata
  • medroxyprogesterone use
  • history of treatment for endogenous Cushing syndrome
Detalhes completos

Fatores de risco

  • systemic glucocorticoid administration
  • high potency or dose of exogenous glucocorticoids
  • prolonged glucocorticoid treatment (e.g., >3 weeks)
  • local glucocorticoid administration
  • megestrol use
  • intermittent high-dose exogenous glucocorticoid
  • nonphysiologic scheduling of glucocorticoid dose
  • medroxyprogesterone use
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • serum comprehensive chemistry panel
  • serum a.m. cortisol
  • adrenocorticotropic hormone (ACTH) stimulation test
  • CBC
  • thyroid function tests
Detalhes completos

Investigações a serem consideradas

  • insulin tolerance test (ITT)
  • overnight metyrapone test
  • urine synthetic glucocorticoids
Detalhes completos

Novos exames

  • home waking salivary cortisone

Algoritmo de tratamento

Inicial

features of adrenal crisis

AGUDA

minor intercurrent stress

severe intercurrent stress

CONTÍNUA

stable patients taking corticosteroids for underlying disease: suitable for discontinuation or taper

Colaboradores

Autores

Suzanne L. Quinn Martinez, MD
Suzanne L. Quinn Martinez

Staff Endocrinologist

HCA Florida Orange Park

Program Director, Internal Medicine

Orange Park

FL

Declarações

SLQM declares that she has no competing interests.

Agradecimentos

Dr Suzanne L. Quinn Martinez would like to gratefully acknowledge Dr M. Cecilia Lansang, a previous contributor to this topic.

Declarações

MCL is a consultant for the Sanofi group of companies and is an author of several references cited in this topic.

Revisores

Tiffany M Cortes, MD

Assistant Professor of Medicine

Division of Endocrinology

UT Health Science Center San Antonio

San Antonio

TX

Declarações

TMC declares that she has no competing interests.

Antoine Tabarin, MD

Head

Department of Endocrinology

University Hospital of Bordeaux

Pessac

France

Declarações

AT declares that he has no competing interests.

Maralyn Druce, MA, MBBS, MRCP, PhD

Clinical Lecturer

Honorary Consultant

Department of Endocrinology

Barts and The London School of Medicine and Dentistry

St Bartholomew's Hospital

London

UK

Declarações

MD declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Prete A, Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ. 2021 Jul 12;374:n1380.Texto completo  Resumo

Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013 Aug 15;9(1):30.Texto completo  Resumo

Beuschlein F, Else T, Bancos I, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. J Clin Endocrinol Metab. 2024 Jun 17;109(7):1657-83.Texto completo  Resumo

Arlt W; Society for Endocrinology Clinical Committee. Society for Endocrinology endocrine emergency guidance: emergency management of acute adrenal insufficiency (adrenal crisis) in adult patients. Endocr Connect. 2016 Sep;5(5):G1-3.Texto completo  Resumo

Woodcock T, Barker P, Daniel S, et al. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. Anaesthesia. 2020 May;75(5):654-63.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

  • Diagnósticos diferenciais

    • Primary adrenal insufficiency
    • Pituitary compression, tumor, head trauma, and surgery (non-Cushing)
    • Corticosteroid withdrawal syndrome
    Mais Diagnósticos diferenciais

  • Diretrizes

    • European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency
    • Adrenal suppression from exogenous glucocorticoids: recognizing risk factors and preventing morbidity
    Mais Diretrizes
  • padlock-lockedConectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal