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Supressão adrenal

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  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 21 Dec 2025
Last updated: 02 May 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • cessação súbita ou redução rápida de glicocorticoides
  • colapso circulatório agudo com hipotensão e taquicardia
Full details

Other diagnostic factors

  • lassidão e sintomas constitucionais generalizados
  • história de ganho de peso e aumento do apetite
  • história de depressão, agitação ou distúrbios do sono
  • características cushingoides ao exame
  • história de diabetes de difícil controle ou hipertensão
  • ausência de hiperpigmentação ou estigmas autoimunes
  • uso de medroxiprogesterona
  • história de tratamento endógeno para a síndrome de Cushing
Full details

Risk factors

  • administração sistêmica de glicocorticoide
  • alta potência ou dose de glicocorticoides exógenos
  • tratamento prolongado com glicocorticoide (por exemplo, >3 semanas)
  • administração local de glicocorticoide
  • uso de megestrol
  • glicocorticoide exógeno intermitente em altas doses
  • programação não fisiológica da dose de glicocorticoide
  • uso de medroxiprogesterona
Full details

Diagnostic tests

1st tests to order

  • perfil bioquímico sérico abrangente
  • cortisol sérico matinal
  • teste de estímulo com o hormônio adrenocorticotrópico (ACTH)
  • Hemograma completo
  • testes da função tireoidiana
Full details

Tests to consider

  • teste de tolerância à insulina (TTI)
  • teste da metirapona noturna
  • glicocorticoides sintéticos urinários
Full details

Emerging tests

  • cortisona salivar matinal domiciliar

Treatment algorithm

INITIAL

características da crise adrenal

ACUTE

estresse intercorrente leve

estresse intercorrente intenso

ONGOING

pacientes estáveis que estão tomando corticosteroides para doença subjacente: elegíveis para descontinuação ou esquema de retirada gradual

Contributors

Authors

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

Staff Endocrinologist

HCA Florida Orange Park

Program Director, Internal Medicine

Orange Park

FL

Disclosures

SLQM declares that she has no competing interests.

Acknowledgements

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

Disclosures

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

Peer reviewers

Tiffany M Cortes, MD

Assistant Professor of Medicine

Division of Endocrinology

UT Health Science Center San Antonio

San Antonio

TX

Disclosures

TMC declares that she has no competing interests.

Antoine Tabarin, MD

Head

Department of Endocrinology

University Hospital of Bordeaux

Pessac

France

Disclosures

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

Disclosures

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Prete A, Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ. 2021 Jul 12;374:n1380.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • Differentials

    • Insuficiência adrenal primária
    • Compressão da hipófise, tumor, trauma cranioencefálico e cirurgia (não Cushing)
    • Síndrome de abstinência de corticosteroides
    More Differentials

  • Guidelines

    • European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: diagnosis and therapy of glucocorticoid-induced adrenal insufficiency
    • Adrenal insufficiency and adrenal crisis-who is at risk and how should they be managed safely
    More Guidelines
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