New guidelines for people at risk of adrenal insufficiency due to steroid-based medications

The joint guidelines will help European and US clinicians manage patients who have or are at risk of developing glucocorticoid-induced adrenal insufficiency.

Location of the adrenal glands in the human body

At least 1% of the global population uses chronic glucocorticoid therapy as anti-inflammatory or immune-suppressive agents.

The guideline, titled “Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency,” appeared in the May 2024 issues of the Endocrine Society’s and the European Society of Endocrinology’s (ESE) respective journals: The Journal of Clinical Endocrinology & Metabolism and the European Journal of Endocrinology. Patient-facing materials on glucocorticoid-induced adrenal insufficiency have also been developed and were made available via the ESE Patient Zone in May 2024.

This is the first guideline developed and published jointly by the two Societies. It is also the first guideline focusing on this topic since glucocorticoids were first used in clinical practice in the 1940s, and aims to standardise the approach to this challenging condition.

The hypothalamo–pituitary–adrenal (HPA) stress axis

Guideline development at each Society is overseen by a clinical committee, and all guidelines are subject to a rigorous review process before being published. This is undertaken by Society members and relevant parties, such as patient advocacy groups.

Two University of Birmingham academics were part of the working group behind this joint guideline, Professor Niki Karavitaki and Dr Alessandro Prete.  Professor Niki Karavitaki, Professor of Endocrinology, said:  “This guideline fills an important gap in the clinical practice of many specialties and aids clinicians managing patients on chronic glucocorticoid therapy. Both Alessandro and I were honoured to be amongst the international experts invited to produce this piece of work that will have global reach”.