Glucocorticoid-induced adrenal insuffi ciency and glucocorticoid withdrawal syndrome: Two sides of the same coin

Abstract

Diseases of the adrenal glands can lead to primary adrenal insuffi ciency, and suppression of the hypothalamic-pituitary-adrenal axis can cause secondary adrenal insuffi ciency (adrenal suppression). The most common cause of adrenal suppression is exogenous steroids, a condition recently termed glucocorticoid-induced adrenal insuffi ciency (GIAI). Similarly, weaning from high doses of glucocorticoids or giving insuffi cient glucocorticoid replacement after curative surgery for endogenous hypercortisolism (Cushing syndrome) can lead to glucocorticoid withdrawal syndrome, which overlaps with GIAI.