15
Table 5. Clinical Features of Adrenal Insufficiency,
Glucocorticoid Withdrawal Syndrome and Common
Underlying Conditions
Glucocorticoid
withdrawal
syndrome
Adrenal
insufficiency
Underlying
condition for which
glucocorticoids
were initially
prescribed
Biochemistry Normal electrolytes
Glucocorticoid-
induced hyperglycemia
may be present
Hyponatremia,
hypoglycemia
Biomarkers of disease
activity (sedimentation
rate, disease-specific
biomarkers)
HPA axis Testing is not
recommended
If tested, ACTH and
cortisol are usually
undetectable
Initially, low
ACTH and
cortisol
Later in recovery:
normal-elevated
ACTH, low
cortisol
Not applicable
Risk of adrenal
crisis
Unlikely, if
glucocorticoids
are administered
(as patients with
glucocorticoid
withdrawal syndrome
also have adrenal
insufficiency)
Yes, if not
optimally
treated with
glucocorticoid
therapy
Not applicable
(*) Weight loss due to resolving GC induced Cushing syndrome should be considered.
(cont'd)
