Adrenal suppression

Adrenal suppression is the inadequate adrenal production of cortisol due to suppression of the hypothalamic-pituitary-adrenal axis.

It may present clinically as adrenal insufficiency in instances of rapid tapering or cessation of exogenous glucocorticoids or withdrawal from endogenous glucocorticoid excess (e.g., following treatment of Cushing's disease or an adrenal tumour causing Cushing's syndrome).

The adrenocorticotropic hormone stimulation test is generally the most useful test to detect adrenal suppression.

Preventive measures include minimising corticosteroid dose and duration when possible.

Treatment consists of augmented corticosteroid therapy plus supportive care for any intercurrent stress or overt signs of adrenal insufficiency.

Adrenal suppression refers to decreased cortisol production as a result of negative feedback on the hypothalamic-pituitary-adrenal axis, caused by excess glucocorticoids.[1]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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765115 http://www.ncbi.nlm.nih.gov/pubmed/23947590?tool=bestpractice.com 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.[2]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