[Steroid withdrawal syndrome. A current problem of outpatient medicine]

In contrast to a widespread belief, the authors consider a single measurement of serum cortisol concentration in the early morning to be a reliable and simple outpatient screening method for detecting spontaneous or iatrogenic adrenal insufficiency. In patients on steroids the method allows detection of iatrogenic damage to the adrenals while steroid therapy is still continuing. Important guidelines for the conduct of a planned attempt to withdraw steroids can thus be obtained. Routine use of early morning cortisol measurements has greatly improved clinical knowledge about the multifaceted steroid-withdrawal syndromes (SWS). The symptoms of classical adrenal insufficiency in the form of SWS are described, as are the often atypical signs and symptoms occurring when the disease initially calling for steroid treatment is still active during attempts to lower the therapeutic dose. In addition, attention is drawn to SWS due to psychological causes.