19
(cont'd)
Factors increasing the risk of
glucocorticoid-induced adrenal
insufficiency
Strategies to mitigate the risk of
glucocorticoid-induced adrenal
insufficiency
4
• Long-term use of high-potency
glucocorticoids on large surface areas or areas
of increased absorption (e.g., mucosa)
• Prolonged use on inflamed skin with impaired
barrier function
• Occlusive dressings
• Use on mucous membranes, eyelids, and
scrotum
• Concomitant use of other glucocorticoid
formulations
• Concomitant treatment with strong
cytochrome P450 3A4 inhibitors
3
• Use the smallest effective quantity
for the shortest period
• Use lower potency glucocorticoids,
if possible
• Avoid co-administration with
strong cytochrome P450 3A4
inhibitors
3
• Long-term use
• Concomitant use of other glucocorticoid
formulations
• Concomitant treatment with strong
cytochrome P450 3A4 inhibitors
3
• Use the lowest effective
glucocorticoid dose for the shortest
period
• Avoid co-administration with
strong cytochrome P450 3A4
inhibitors
3
Table 7. Signs and Symptoms of Glucocorticoid-induced
(Exogenous) Cushing Syndrome
Symptoms Muscle weakness
Sleep disturbances (insomnia)
Increased appetite
Mood and cognitive disturbances (irritability, impaired memory,
depression)
Signs Proximal muscle weakness and wasting
Excess weight gain and central obesity
Supraclavicular and dorsocervical fat accumulation
Facial and upper neck plethora with facial rounding
Skin atrophy with easy bruising, red stretch marks, and poor wound
healing
Acne
Menstrual irregularities in women.
Other
manifestations
Cardiometabolic risk factors (hypertension, dysglycemia, dyslipidemia,
hypercoagulability)
Osteoporosis and fragility fractures
Hypogonadism, reduced libido, and reduced fertility
