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Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
Published on: April 25, 2016
Withdrawal from glucocorticosteroid therapy: clinical practice recommendations
Crésio Alves1, Teresa Cristina Vicente Robazzi, Milena Mendonça
1Departamento de Pediatria, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA. cresio.alves@uol.com.br
Jornal De Pediatria
|June 7, 2008
Summary
Safely withdrawing glucocorticosteroids requires gradual tapering to avoid adrenal insufficiency and disease relapse. This review offers practical guidance for clinicians managing glucocorticoid withdrawal in patients.
Area of Science:
- Endocrinology
- Pharmacology
- Pediatrics
Background:
- Glucocorticosteroids are widely used but prolonged therapy can suppress the hypothalamic-pituitary-adrenal (HPA) axis.
- Abrupt cessation can lead to adrenal insufficiency, steroid withdrawal syndrome, or disease exacerbation.
Purpose of the Study:
- To provide an updated, practical review on the safe discontinuation of glucocorticosteroid therapy.
- To guide clinicians in recognizing and managing potential complications during glucocorticoid withdrawal.
Main Methods:
- Literature review of MEDLINE and LILACS databases (1997-2007).
- Selection of representative articles on glucocorticoid withdrawal.
- Inclusion of a brief overview of glucocorticoid pharmacology.
Main Results:
- Potential complications include adrenal insufficiency, steroid withdrawal syndrome, and disease relapse.
- Gradual withdrawal is universally recommended, though specific protocols lack consensus.
- Pediatricians are updated on recognizing and managing these issues.
Conclusions:
- No reliable predictive test exists for adrenal insufficiency risk in patients on chronic corticosteroid therapy.
- Prospective studies are needed to determine the true incidence of adrenal insufficiency and develop prevention strategies.
- Patients on chronic/high-dose glucocorticoids require stress-dose steroids unless HPA axis integrity is confirmed by dynamic testing.
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