Adrenal suppression

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.

Adrenal suppression refers to decreased cortisol production as a result of negative feedback on the hypothalamic-pituitary-adrenal axis, caused by excess glucocorticoids. The consequence is decreased production of both corticotropin-releasing hormone from the hypothalamus and adrenocorticotropic hormone from the pituitary gland, leading to a decrease in serum cortisol levels.[1]Schlaghecke R, Kornely E, Santen RT, et al. The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N Engl J Med. 1992 Jan 23;326(4):226-30. http://www.nejm.org/doi/full/10.1056/NEJM199201233260403#t=article http://www.ncbi.nlm.nih.gov/pubmed/1309389?tool=bestpractice.com