[Drug-induced adrenal insufficiency]

Many drugs may influence the hypothalamic-pituitary-adrenal axis (HPA-Axis) at different levels. Since the discovery of the pharmacological effect of glucocorticoids (GC) and the first application of cortisone (then known as "Compound E") in patients with rheumatoid arthritis in 1948, exogenous glucocorticoids have been the most common cause of drug-induced adrenocortical insufficiency. In the last few years, immune check point inhibitors (ICI) have become a new important cause. Due to the insidious and unspecific symptoms, which can also be a consequence of the underlying disease and its therapies, the diagnosis is often delayed. Regular screening by the attending physicians is essential for prompt recognition of the condition and reduction of the associated morbidity. This article summarizes the most common implicated drugs (GC, ICI and opioids) and the corresponding management recommendations.