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Iatrogenic adrenal insufficiency in adults
Julie Martin-Grace1,2, Maria Tomkins1,2, Michael W O'Reilly1,2
1Department of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland.
Nature Reviews. Endocrinology
|January 25, 2024
Summary
Iatrogenic adrenal insufficiency (IAI), often caused by glucocorticoids, is common in adults. Early diagnosis and careful management are crucial to prevent adrenal crisis and improve patient outcomes.
Area of Science:
- Endocrinology
- Internal Medicine
Background:
- Iatrogenic adrenal insufficiency (IAI) is the most prevalent form of adrenal insufficiency in adults, yet its exact prevalence is not well-defined.
- IAI is linked to severe clinical outcomes, including adrenal crisis, diminished quality of life, and increased mortality.
Purpose of the Study:
- To review the causes, clinical consequences, diagnosis, and management of IAI.
- To provide guidance for clinicians on identifying at-risk patients, screening strategies, and optimizing treatment for IAI, focusing on emergency care and adrenal crisis prevention.
Main Methods:
- Comprehensive literature review of iatrogenic adrenal insufficiency.
- Analysis of current treatment strategies, limitations, and emerging developments.
Main Results:
- IAI management, especially glucocorticoid-induced, presents challenges in balancing hormone replacement with minimizing adverse effects.
- Optimizing hypothalamic-pituitary-adrenal axis recovery is a key consideration in treatment.
Conclusions:
- A high index of suspicion is essential for timely diagnosis and management of IAI.
- Effective management requires balancing glucocorticoid replacement with minimizing cardiometabolic risks and promoting HPA axis recovery.
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