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2017 ; 6
(4
): 269-273
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Recovery of steroid induced adrenal insufficiency
#MMPMID29184808
Younes AK
; Younes NK
Transl Pediatr
2017[Oct]; 6
(4
): 269-273
PMID29184808
show ga
Secondary adrenal insufficiency can result from insufficient stimulation of the
adrenal glands due to inadequate secretion or synthesis of adrenocorticotropic
hormone (ACTH). This can be caused by hypopituitarism, central nervous system
injury (tumors, radiation, and surgery) or long-term glucocorticoid therapy.
Glucocorticoids were introduced in the 1950s, and have been used for their
anti-inflammatory and other pharmacological effects, and also as replacement
therapy for adrenal insufficiency. However, chronic glucocorticoid use may lead
to suppression of the hypothalamic pituitary adrenal axis through negative
feedback. This may lead to secondary adrenal insufficiency. Typically, the
hypothalamic pituitary adrenal axis recovers after cessation of glucocorticoids,
but the timing of recovery can be variable and can take anywhere from 6-12
months. Understanding the effect of exogenous glucocorticoids on the hypothalamic
pituitary adrenal axis, recovery of the axis, and tests used to assess the
recovery, are crucial to avoid prescribing unnecessary steroid replacement or
missing a critical diagnosis with detrimental consequences.