[Secondary adrenal insufficiency due to exogenous glucocorticoid therapy]

Prolonged glucocorticoid therapy is considered to be the most common cause of secondary adrenal insufficiency. Despite this, its true incidence remains unknown and the risk of acute adrenal insufficiency seems to be overestimated. The cosyntropin stimulation test is a very valuable test to assess the adrenal reserve but not to predict the risk of acute adrenal insufficiency. Otherwise, this test is well correlated with the adrenal response to a stress but not with clinical events. The corticosteroid withdrawal modalities are very heterogeneous, non-consensual, and have never been strictly evaluated. Several studies have demonstrated that the need for glucocorticoids coverage during a stress has been overestimated and that hydrocortisone doses should not necessarily be markedly increased. A prospective study of patients after withdrawal would be the only mean to assess the true incidence of this complication and to propose a rational strategy to prevent it. Meanwhile, the education of patients and physicians should be a mandatory step in the management of the patients with a potential risk of adrenal insufficiency.