5
Recommendation 2.8
➤ We suggest against routinely performing a dynamic test for diagnosing
adrenal insufficiency in patients tapering or stopping glucocorticoid
therapy. (
⊕
)
Recommendation 2.9
➤ We suggest awareness of possible glucocorticoid-induced adrenal
insufficiency in patients:
1. with current or recent use of non-oral glucocorticoid formulations presenting
with signs and symptoms indicative of adrenal insufficiency, or
2. using multiple glucocorticoid formulations simultaneously, or
3. using high dose inhaled or topical glucocorticoids, or
4. using inhaled or topical glucocorticoids for >1 year, or
5. who received intra-articular glucocorticoid injections in the previous 2 months, or
6. receiving concomitant treatment with strong cytochrome P450 3A4 inhibitors.
Recommendation 2.10
➤ We suggest that patients with current or previous glucocorticoid
treatment presenting with signs and symptoms of exogenous Cushing
syndrome are assumed to have glucocorticoid-induced adrenal
insufficiency. (GCP)
Recommendation 2.11
➤ We suggest that patients aiming to discontinue glucocorticoids, but
without recovery of HPA axis in one year while on physiologic daily
dose equivalent, should be evaluated by an endocrinology specialist.
We suggest that patients on glucocorticoids and history of adrenal
crisis should also be evaluated by an endocrinology specialist. (GCP)
Recommendation 2.12
➤ We recommend against the use of fludrocortisone in patients with
glucocorticoid-induced adrenal insufficiency.
