3
Management
1. General Recommendations for Glucocorticoid Therapy
of Non-Endocrine Conditions and Recommendations
Regarding Patient Education
Recommendation 1.1
➤ We recommend that, in general, patients on, or tapering off
glucocorticoids for non-endocrine conditions do not need to be
evaluated by an endocrinology specialist.
Recommendation 1.2
➤ We recommend that clinicians who implement treatment with
glucocorticoids educate patients about various endocrine aspects of
glucocorticoid therapy. (Good Clinical Practice [GCP])
Recommendation 1.3
➤ We recommend that patients on glucocorticoid therapy have access
to current up-to-date and appropriate information about different
endocrine aspects of glucocorticoid therapy. (GCP)
2. Recommendations Regarding Taper of Systemic
Glucocorticoid Therapy for Non-Endocrine Conditions,
Diagnosis and Approach to Glucocorticoid-Induced Adrenal
Insufficiency, and Glucocorticoid Withdrawal Syndrome
Recommendation 2.1
➤ We suggest not to taper glucocorticoids in patients on short-term
glucocorticoid therapy of <3–4 weeks, irrespective of the dose. In
these cases, glucocorticoids can be stopped without testing due to
low concern for HPA axis suppression. (
⊕
)
Recommendation 2.2
➤ Glucocorticoid taper for patients on long-term glucocorticoid
therapy should only be attempted if the underlying disease for which
glucocorticoids were prescribed is controlled, and glucocorticoids are
no longer required. In these cases, glucocorticoids are tapered until
approaching the physiologic daily dose equivalent is achieved (e.g., 4–6
mg prednisone). (GCP)
Recommendation 2.3
➤ We recommend consideration of glucocorticoid withdrawal syndrome
that may occur during glucocorticoid taper. When glucocorticoid
withdrawal syndrome is severe, glucocorticoid dose can be temporarily
increased to the most recent one that was tolerated, and the duration
of glucocorticoid taper could be increased. (GCP)
