[How to plan glucocorticoid withdrawal: diagnostic and therapeutic strategies].
Glucocorticoïds are widely used in medicine and associated with numerous complications. Whenever possible, dosage reduction or treatment withdrawal should be considered as soon as possible depending on the underlying disease being treated. Administration of glucocorticoids induces a physiologic negative feed-back on the hypothalamic-pituitary-adrenal (HPA) axis and three clinical situations can be distinguished during treatment withdrawal: reactivation of the disease for which the glucocorticoids were prescribed, acute adrenal insufficiency and steroid withdrawal syndrome. Acute adrenal insufficiency is a feared complication but probably rare. It is usually seen during stress situations and can be observed long after steroid withdrawal. There is no good predictive marker to anticipate acute adrenal insufficiency and clinical evaluation of the patient remains a key element in its diagnosis. If adrenal insufficiency is suspected, HPA suppression can be assessed with dynamic tests. During stress situation, steroid administration is then recommended depending on the severity of the stress.
Vollenweider
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Service de Médecine Interne B, CHUV, Lausanne. Peter.Vollenweider@chuv.hospvd.ch
Waeber
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D000208:Acute Disease; D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000175:diagnosis; D000324:Adrenocorticotropic Hormone; D000368:Aged; D000963:Antimetabolites; D002940:Circadian Rhythm; D004791:Enzyme Inhibitors; D005246:Feedback; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects*; D006207:Half-Life; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D007328:Insulin; D008797:Metyrapone; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D013312:Stress, Physiological / Q000097:blood / Q000503:physiopathology; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors
D000963:Antimetabolites; D004791:Enzyme Inhibitors; D005938:Glucocorticoids; D007328:Insulin; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D008797:Metyrapone