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3. Recommendations on Diagnosis and Therapy of Adrenal
Crisis in Patients With Glucocorticoid-induced Adrenal
Insufficiency
Recommendation 3.1
➤ We recommend that patients with current or recent glucocorticoid use
who did not undergo biochemical testing to rule out glucocorticoid-
induced adrenal insufficiency should receive stress dose coverage
when they are exposed to stress. (GCP)
Recommendation 3.1A
• Oral glucocorticoids should be used in case of minor stress and when there are no
signs of hemodynamic instability or prolonged vomiting or diarrhea.
Recommendation 3.1B
• Parenteral glucocorticoids should be used in case of moderate to major stress,
procedures under general or regional anesthesia, procedures requiring prolonged
avoidance or inability of oral intake, or when there are signs of hemodynamic
instability or prolonged vomiting or diarrhea.
Recommendation 3.2
➤ We suggest that in patients with current or recent glucocorticoid use
who did not undergo biochemical testing to rule out glucocorticoid-
induced adrenal insufficiency and present with hemodynamic
instability, vomiting, or diarrhea, the diagnosis of adrenal crisis
should be considered irrespective of the glucocorticoid type,
mode of administration, and dose; patients with suspected adrenal
crisis should be treated with parenteral glucocorticoids and fluid
resuscitation. (GCP)
Management
